Rex D K, Cutler C S, Lemmel G T, Rahmani E Y, Clark D W, Helper D J, Lehman G A, Mark D G
Department of Medicine, Indiana University School of Medicine, Indianapolis, USA.
Gastroenterology. 1997 Jan;112(1):24-8. doi: 10.1016/s0016-5085(97)70214-2.
BACKGROUND & AIMS: The miss rate of colonoscopy for neoplasms is poorly understood. The aim of this study was to determine the miss rate of colonoscopy by same day back-to-back colonoscopy.
Two consecutive same day colonoscopies were performed in 183 patients. The patients were randomized to undergo the second colonoscopy by the same or a different endoscopist and in the same or different position.
The overall miss rate for adenomas was 24%, 27% for adenomas < or = 5 mm, 13% for adenomas 6-9 mm, and 6% for adenomas > or = 1 cm. Patients with two or more adenomas at the first examination were more likely than patients with no or one adenoma detected at the first examination to have one or more adenomas at the second examination (odds ratio, 3.3; 95% confidence interval, 1.69-6.46). Right colon adenomas were missed more often (27%) than left colon adenomas (21%), but the difference was not significant. There was evidence of variation in sensitivity between endoscopists, but significant miss rates for small adenomas were found among essentially all endoscopists.
Using current colonoscopic technology, there are significant miss rates for adenomas < 1 cm even with meticulous colonoscopy. Miss rates are low for adenomas > or = 1 cm. The results suggest the need for improvements in colonoscopic technology.
结肠镜检查对肿瘤的漏诊率尚不清楚。本研究旨在通过同日连续结肠镜检查确定结肠镜检查的漏诊率。
对183例患者进行了连续两次同日结肠镜检查。患者被随机分配由同一位或另一位内镜医师在相同或不同体位下进行第二次结肠镜检查。
腺瘤的总体漏诊率为24%，直径≤5mm的腺瘤漏诊率为27%，直径6 - 9mm的腺瘤漏诊率为13%，直径≥1cm的腺瘤漏诊率为6%。首次检查发现两个或更多腺瘤的患者比首次检查未发现或仅发现一个腺瘤的患者在第二次检查时更有可能出现一个或多个腺瘤（比值比，3.3；95%置信区间，1.69 - 6.46）。右半结肠腺瘤的漏诊率（27%）高于左半结肠腺瘤（21%），但差异无统计学意义。有证据表明内镜医师之间的敏感性存在差异，但基本上所有内镜医师对小腺瘤的漏诊率都较高。
使用当前的结肠镜检查技术，即使进行细致的结肠镜检查，直径<1cm的腺瘤仍有显著的漏诊率。直径≥1cm的腺瘤漏诊率较低。结果表明需要改进结肠镜检查技术。
