Penz Daniela, Pammer Daniel, Waldmann Elisabeth, Asaturi Arno, Szymanska Aleksrandra, Trauner Michael, Ferlitsch Monika
Internal Medicine I, St. John of God Hospital Vienna, Vienna, Austria.
Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria.
Endosc Int Open. 2024 Apr 5;12(4):E488-E497. doi: 10.1055/a-2271-1929. eCollection 2024 Apr.
Serrated lesions have been identified as precursor lesions for 20% to 35% of colorectal cancers (CRCs) and may contribute to a significant proportion of interval-cancer. Sessile-serrated-lesions (SSLs), in particular, tend to be flat and located in the proximal colon, making their detection challenging and requiring expertise. It remains unclear whether the detection rate for serrated polyps should be considered as a quality indicator in addition to the adenoma detection rate (ADR). This study sought to assess whether the ADR has an effect on the detection rate for serrated polyps. In this retrospective analysis, prospectively collected data from 212,668 screening colonoscopies performed between 2012 and September 2018 were included. Spearman correlation and Whitney-Mann U-test were used to assess the association of ADR and the detection rate of SSLs with (SDR) and without hyperplastic polyps (SPADRs), the sessile serrated detection rate (SSLDR) as well as the clinically relevant serrated detection rate (CRSDR), including all SSLs and traditional serrated adenoma, hyperplastic polyps (HPs) >10 mm anywhere in the colon or HPs > 5 mm proximal to the sigmoid. The overall mean ADR was 21.78% (standard deviation [SD] 9.27), SDR 21.08% (SD 11.44), SPADR 2.19% (SD 2.49), and CRSDR was 3.81% (3.40). Significant correlations were found between the ADR and the SDR, SPADR, SSLDR, and CRSDR (rho=0.73 vs. rho=0.51 vs. rho=0.51 vs. rho=0.63; all <0.001). Endoscopists with a mean ADR ≥25% had significantly higher SDR, SPADR, and CRSDR than endoscopists with a mean ADR <25% (all <0.001; Mann-Whitney U-Test). This study shows that endoscopists with higher ADR detect significantly more serrated lesions than those with a lower ADR.
锯齿状病变已被确认为20%至35%的结直肠癌（CRC）的前驱病变，并且可能在相当比例的间隔期癌中起作用。特别是无蒂锯齿状病变（SSL）往往是扁平的，且位于近端结肠，这使得它们的检测具有挑战性，需要专业知识。除腺瘤检出率（ADR）外，锯齿状息肉的检出率是否应被视为一项质量指标仍不明确。本研究旨在评估ADR是否对锯齿状息肉的检出率有影响。在这项回顾性分析中，纳入了2012年至2018年9月期间前瞻性收集的212,668例筛查结肠镜检查的数据。采用Spearman相关性分析和Whitney-Mann U检验来评估ADR与有增生性息肉（SDR）和无增生性息肉（SPADR）时SSL的检出率、无蒂锯齿状病变检出率（SSLDR）以及临床相关锯齿状病变检出率（CRSDR）之间的关联，CRSDR包括所有SSL和传统锯齿状腺瘤、结肠内任何部位直径>10 mm的增生性息肉（HP）或乙状结肠近端直径>5 mm的HP。总体平均ADR为21.78%（标准差[SD]9.27），SDR为21.08%（SD 11.44），SPADR为2.19%（SD 2.49），CRSDR为3.81%（3.40）。发现ADR与SDR、SPADR、SSLDR和CRSDR之间存在显著相关性（rho分别为0.73、0.51、0.51、0.63；均<0.001）。平均ADR≥25%的内镜医师的SDR、SPADR和CRSDR显著高于平均ADR<25%的内镜医师（均<0.001；Mann-Whitney U检验）。本研究表明，ADR较高的内镜医师比ADR较低的内镜医师检测到的锯齿状病变明显更多。
