多靶点粪便 DNA 检测后，最低基线检测者的肿瘤诊断能力得到增强。
Neoplasia Diagnosis After Multi-target Stool DNA Is Enhanced Among Lowest Baseline Detectors.
机构信息
Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA.
出版信息
Dig Dis Sci. 2023 Sep;68(9):3721-3731. doi: 10.1007/s10620-023-08038-5. Epub 2023 Jul 24.
BACKGROUND AND AIMS
Variation in colorectal neoplasia detection limits the effectiveness of screening colonoscopy. By evaluating neoplasia detection rates of individual colonoscopists, we aimed to quantify the effects of pre-procedural knowledge of a positive (+) multi-target stool DNA (mt-sDNA) on colonoscopy quality metrics.
METHODS
We retrospectively identified physicians who performed a high volume of + mt-sDNA colonoscopies; colorectal neoplasia at post-mt-sDNA colonoscopy was recorded. These colonoscopists were stratified into quartiles based on baseline adenoma detection rates. Baseline colonoscopy adenoma detection rates and sessile serrated lesion detection rates were compared to post-mt-sDNA colonoscopy neoplasia diagnosis rates among each quartile. Withdrawal times were measured from negative exams.
RESULTS
During the study period (2014-17) the highest quartile of physicians by volume of post-mt-sDNA colonoscopies were evaluated. Among thirty-five gastroenterologists, their median screening colonoscopy adenoma detection rate was 32% (IQR, 28-39%) and serrated lesion detection rate was 13% (8-15%). After + mt-sDNA, adenoma diagnosis increased to 47% (36-56%) and serrated lesion diagnosis increased to 31% (17-42%) (both p < 0.0001). Median withdrawal time increased from 10 (7-13) to 12 (10-17) minutes (p < 0.0001) and was proportionate across quartiles. After + mt-sDNA, lower baseline detectors had disproportionately higher rates of adenoma diagnosis in female versus male patients (p = 0.048) and higher serrated neoplasia diagnosis rates among all patients (p = 0.0092).
CONCLUSIONS
Knowledge of + mt-sDNA enriches neoplasia diagnosis compared to average risk screening exams. Adenomatous and serrated lesion diagnosis was magnified among those with lower adenoma detection rates. Awareness of the mt-sDNA result may increase physician attention during colonoscopy. Pre-procedure knowledge of a positive mt-sDNA test improves neoplasia diagnosis rates among colonoscopists with lower baseline adenoma detection rates, independent of withdrawal time.
背景和目的
结直肠腺瘤检出率的差异限制了筛查结肠镜的效果。通过评估个体结肠镜医师的腺瘤检出率，我们旨在量化术前了解阳性（+）多靶点粪便 DNA（mt-sDNA）对结肠镜质量指标的影响。
方法
我们回顾性地确定了进行大量+mt-sDNA 结肠镜检查的医生；记录了 post-mt-sDNA 结肠镜检查后的结直肠腺瘤。根据基线腺瘤检出率，将这些结肠镜医师分为四分位组。比较各四分位组基线结肠镜腺瘤检出率和无蒂锯齿状病变检出率与 post-mt-sDNA 结肠镜检查后腺瘤诊断率。从阴性检查中测量退出时间。
结果
在研究期间（2014-17 年），评估了 post-mt-sDNA 结肠镜检查量最高的四分位组的医生。在 35 名胃肠病学家中，他们的中位筛查结肠镜腺瘤检出率为 32%（IQR，28-39%），锯齿状病变检出率为 13%（8-15%）。在+mt-sDNA 后，腺瘤诊断率增加到 47%（36-56%），锯齿状病变诊断率增加到 31%（17-42%）（均 p<0.0001）。退出时间中位数从 10（7-13）增加到 12（10-17）分钟（p<0.0001），并且与四分位组成比例。在+mt-sDNA 后，基线检测值较低的女性患者腺瘤诊断率与男性患者相比不成比例地升高（p=0.048），所有患者的锯齿状肿瘤诊断率也升高（p=0.0092）。
结论
与平均风险筛查检查相比，+mt-sDNA 的知识丰富了腺瘤的诊断。腺瘤和锯齿状病变的诊断在那些腺瘤检出率较低的患者中放大。对 mt-sDNA 结果的认识可能会增加医生在结肠镜检查过程中的注意力。在术前了解阳性 mt-sDNA 检测结果可提高基线腺瘤检出率较低的结肠镜医师的腺瘤检出率，而与退出时间无关。
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