Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study
Adenoma detection rate (ADR) is a well-established quality indicator for colonoscopy and is inversely associated with the incidence of interval post-colonoscopy colorectal cancer. However, interval post-colonoscopy colorectal cancers frequently develop from serrated polyps, which are not included in...
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| Veröffentlicht in: | The lancet. Gastroenterology & hepatology 2022-08, Vol.7 (8), p.747-754 |
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| creator | van Toledo, David E F W M IJspeert, Joep E G Bossuyt, Patrick M M Bleijenberg, Arne G C van Leerdam, Monique E van der Vlugt, Manon Lansdorp-Vogelaar, Iris Spaander, Manon C W Dekker, Evelien |
| description | Adenoma detection rate (ADR) is a well-established quality indicator for colonoscopy and is inversely associated with the incidence of interval post-colonoscopy colorectal cancer. However, interval post-colonoscopy colorectal cancers frequently develop from serrated polyps, which are not included in the ADR. Therefore, the proximal serrated polyp detection rate (PSPDR) has been proposed as a quality indicator, but its association with interval post-colonoscopy colorectal cancer has not been studied. We aimed to evaluate this potential association based on data collected in the Dutch colorectal cancer screening programme.
In this population-based study, using colonoscopy data from the Dutch faecal immunochemical test-based colorectal cancer screening programme and cancer data from the Netherlands Cancer Registry, we evaluated the association between endoscopists' individual PSPDR and their patients' risk of interval post-colonoscopy colorectal cancer with a shared frailty Cox proportional-hazard regression analysis. Participants in the screening programme who were eligible for inclusion were aged 55–76 years, had a positive faecal immunochemical test (cutoff 15 μg Hb/g faeces at start and changed mid-2014 to 47 μg Hb/g faeces), were asymptomatic, and underwent a colonoscopy between Jan 1, 2014, and Dec 31, 2020. The PSPDR was defined as the proportion of colonoscopies in which at least one serrated polyp proximal to the descending colon was detected, confirmed by histopathology. The ADR was defined as the proportion of all colonoscopies in which at least one conventional adenoma was detected, confirmed by histopathology. Detection rates were determined for each endoscopist individually. We additionally evaluated the risk of interval post-colonoscopy colorectal cancer for endoscopists with a PSPDR and ADR above the median versus endoscopists with either one or both parameters below the median. This study is registered with the Netherlands Trial Registry, NL8350.
During the study period, 329 104 colonoscopies were done, of which 277 555, done by 441 endoscopists, were included in the PSPDR calculations. The median PSPDR was 11·9% (IQR 8·3–15·8) and median ADR was 66·3% (61·4–69·9). The correlation between the PSDPR and ADR was moderate (r=0·59; p |
| doi_str_mv | 10.1016/S2468-1253(22)00090-5 |
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In this population-based study, using colonoscopy data from the Dutch faecal immunochemical test-based colorectal cancer screening programme and cancer data from the Netherlands Cancer Registry, we evaluated the association between endoscopists' individual PSPDR and their patients' risk of interval post-colonoscopy colorectal cancer with a shared frailty Cox proportional-hazard regression analysis. Participants in the screening programme who were eligible for inclusion were aged 55–76 years, had a positive faecal immunochemical test (cutoff 15 μg Hb/g faeces at start and changed mid-2014 to 47 μg Hb/g faeces), were asymptomatic, and underwent a colonoscopy between Jan 1, 2014, and Dec 31, 2020. The PSPDR was defined as the proportion of colonoscopies in which at least one serrated polyp proximal to the descending colon was detected, confirmed by histopathology. The ADR was defined as the proportion of all colonoscopies in which at least one conventional adenoma was detected, confirmed by histopathology. Detection rates were determined for each endoscopist individually. We additionally evaluated the risk of interval post-colonoscopy colorectal cancer for endoscopists with a PSPDR and ADR above the median versus endoscopists with either one or both parameters below the median. This study is registered with the Netherlands Trial Registry, NL8350.
During the study period, 329 104 colonoscopies were done, of which 277 555, done by 441 endoscopists, were included in the PSPDR calculations. The median PSPDR was 11·9% (IQR 8·3–15·8) and median ADR was 66·3% (61·4–69·9). The correlation between the PSDPR and ADR was moderate (r=0·59; p<0·0001). During a median follow-up of 33 months (IQR 21–42), 305 interval post-colonoscopy colorectal cancers were detected. For each percentage point increase in PSPDR, the adjusted interval post-colonoscopy colorectal cancer hazard was 7% lower (hazard ratio [HR] 0·93, 95% CI 0·90–0·95; p<0·0001). Compared with endoscopists with a PSPDR greater than 11·9% and ADR greater than 66·3%, the HR of interval post-colonoscopy colorectal cancer for endoscopists with a low PSPDR and high ADR was 1·79 (95% CI 1·22–2·63), for endoscopists with a high PSPDR and low ADR was 1·97 (1·19–3·24), and for endoscopists with a low PSPDR and low ADR was 2·55 (1·89–3·45).
The PSPDR of an endoscopist is inversely associated with the incidence of interval post-colonoscopy colorectal cancer. Implementation of PSPDR monitoring, in addition to ADR monitoring, could optimise colorectal cancer prevention.
None.</description><identifier>ISSN: 2468-1253</identifier><identifier>EISSN: 2468-1253</identifier><identifier>DOI: 10.1016/S2468-1253(22)00090-5</identifier><identifier>PMID: 35550250</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Adenoma - diagnosis ; Adenoma - epidemiology ; Adenoma - pathology ; Colonic Polyps - diagnosis ; Colonic Polyps - epidemiology ; Colonic Polyps - pathology ; Colonoscopy ; Colorectal Neoplasms - diagnosis ; Colorectal Neoplasms - epidemiology ; Colorectal Neoplasms - pathology ; Early Detection of Cancer ; Humans</subject><ispartof>The lancet. Gastroenterology & hepatology, 2022-08, Vol.7 (8), p.747-754</ispartof><rights>2022 Elsevier Ltd</rights><rights>Copyright © 2022 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c412t-e8a6c449d85e5714a7b525ba75141814c29301a7b6b7ac1f8c1c2585c6462a853</citedby><cites>FETCH-LOGICAL-c412t-e8a6c449d85e5714a7b525ba75141814c29301a7b6b7ac1f8c1c2585c6462a853</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27907,27908</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35550250$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van Toledo, David E F W M</creatorcontrib><creatorcontrib>IJspeert, Joep E G</creatorcontrib><creatorcontrib>Bossuyt, Patrick M M</creatorcontrib><creatorcontrib>Bleijenberg, Arne G C</creatorcontrib><creatorcontrib>van Leerdam, Monique E</creatorcontrib><creatorcontrib>van der Vlugt, Manon</creatorcontrib><creatorcontrib>Lansdorp-Vogelaar, Iris</creatorcontrib><creatorcontrib>Spaander, Manon C W</creatorcontrib><creatorcontrib>Dekker, Evelien</creatorcontrib><title>Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study</title><title>The lancet. Gastroenterology & hepatology</title><addtitle>Lancet Gastroenterol Hepatol</addtitle><description>Adenoma detection rate (ADR) is a well-established quality indicator for colonoscopy and is inversely associated with the incidence of interval post-colonoscopy colorectal cancer. However, interval post-colonoscopy colorectal cancers frequently develop from serrated polyps, which are not included in the ADR. Therefore, the proximal serrated polyp detection rate (PSPDR) has been proposed as a quality indicator, but its association with interval post-colonoscopy colorectal cancer has not been studied. We aimed to evaluate this potential association based on data collected in the Dutch colorectal cancer screening programme.
In this population-based study, using colonoscopy data from the Dutch faecal immunochemical test-based colorectal cancer screening programme and cancer data from the Netherlands Cancer Registry, we evaluated the association between endoscopists' individual PSPDR and their patients' risk of interval post-colonoscopy colorectal cancer with a shared frailty Cox proportional-hazard regression analysis. Participants in the screening programme who were eligible for inclusion were aged 55–76 years, had a positive faecal immunochemical test (cutoff 15 μg Hb/g faeces at start and changed mid-2014 to 47 μg Hb/g faeces), were asymptomatic, and underwent a colonoscopy between Jan 1, 2014, and Dec 31, 2020. The PSPDR was defined as the proportion of colonoscopies in which at least one serrated polyp proximal to the descending colon was detected, confirmed by histopathology. The ADR was defined as the proportion of all colonoscopies in which at least one conventional adenoma was detected, confirmed by histopathology. Detection rates were determined for each endoscopist individually. We additionally evaluated the risk of interval post-colonoscopy colorectal cancer for endoscopists with a PSPDR and ADR above the median versus endoscopists with either one or both parameters below the median. This study is registered with the Netherlands Trial Registry, NL8350.
During the study period, 329 104 colonoscopies were done, of which 277 555, done by 441 endoscopists, were included in the PSPDR calculations. The median PSPDR was 11·9% (IQR 8·3–15·8) and median ADR was 66·3% (61·4–69·9). The correlation between the PSDPR and ADR was moderate (r=0·59; p<0·0001). During a median follow-up of 33 months (IQR 21–42), 305 interval post-colonoscopy colorectal cancers were detected. For each percentage point increase in PSPDR, the adjusted interval post-colonoscopy colorectal cancer hazard was 7% lower (hazard ratio [HR] 0·93, 95% CI 0·90–0·95; p<0·0001). Compared with endoscopists with a PSPDR greater than 11·9% and ADR greater than 66·3%, the HR of interval post-colonoscopy colorectal cancer for endoscopists with a low PSPDR and high ADR was 1·79 (95% CI 1·22–2·63), for endoscopists with a high PSPDR and low ADR was 1·97 (1·19–3·24), and for endoscopists with a low PSPDR and low ADR was 2·55 (1·89–3·45).
The PSPDR of an endoscopist is inversely associated with the incidence of interval post-colonoscopy colorectal cancer. Implementation of PSPDR monitoring, in addition to ADR monitoring, could optimise colorectal cancer prevention.
None.</description><subject>Adenoma - diagnosis</subject><subject>Adenoma - epidemiology</subject><subject>Adenoma - pathology</subject><subject>Colonic Polyps - diagnosis</subject><subject>Colonic Polyps - epidemiology</subject><subject>Colonic Polyps - pathology</subject><subject>Colonoscopy</subject><subject>Colorectal Neoplasms - diagnosis</subject><subject>Colorectal Neoplasms - epidemiology</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Early Detection of Cancer</subject><subject>Humans</subject><issn>2468-1253</issn><issn>2468-1253</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkM9LwzAUx4Mobsz9CUqP81BN0iRtvYgMf8HAw_Qc0vQVMrumJu2g_73ppsObpzxePu99eR-ELgm-IZiI2zVlIosJ5cmC0muMcY5jfoKmx_bpn3qC5t5vAkTSRIgkO0eThHOOKcdTtFmDc6qDMmptPbRRCR3oztgmUk0ZOeM_I1tFpunA7VQdIN_F2ta2sV7bdojG2oWJ8KdVo8HdRSpQbV-rcUtcKB92-64vhwt0Vqnaw_znnaGPp8f35Uu8ent-XT6sYs0I7WLIlNCM5WXGgaeEqbTglBcq5YSRjDBN8wST0BVFqjSpMk005RnXggmqMp7M0OKwt3X2qwffya3xGupaNWB7L6kQLM0Jz3FA-QHVznrvoJKtM1vlBkmwHE3LvWk5apSUyr1pOUZc_UT0xRbK49Sv1wDcHwAIh-4MOOm1geCnNKMtWVrzT8Q3bWeN-w</recordid><startdate>202208</startdate><enddate>202208</enddate><creator>van Toledo, David E F W M</creator><creator>IJspeert, Joep E G</creator><creator>Bossuyt, Patrick M M</creator><creator>Bleijenberg, Arne G C</creator><creator>van Leerdam, Monique E</creator><creator>van der Vlugt, Manon</creator><creator>Lansdorp-Vogelaar, Iris</creator><creator>Spaander, Manon C W</creator><creator>Dekker, Evelien</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202208</creationdate><title>Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study</title><author>van Toledo, David E F W M ; IJspeert, Joep E G ; Bossuyt, Patrick M M ; Bleijenberg, Arne G C ; van Leerdam, Monique E ; van der Vlugt, Manon ; Lansdorp-Vogelaar, Iris ; Spaander, Manon C W ; Dekker, Evelien</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c412t-e8a6c449d85e5714a7b525ba75141814c29301a7b6b7ac1f8c1c2585c6462a853</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adenoma - diagnosis</topic><topic>Adenoma - epidemiology</topic><topic>Adenoma - pathology</topic><topic>Colonic Polyps - diagnosis</topic><topic>Colonic Polyps - epidemiology</topic><topic>Colonic Polyps - pathology</topic><topic>Colonoscopy</topic><topic>Colorectal Neoplasms - diagnosis</topic><topic>Colorectal Neoplasms - epidemiology</topic><topic>Colorectal Neoplasms - pathology</topic><topic>Early Detection of Cancer</topic><topic>Humans</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van Toledo, David E F W M</creatorcontrib><creatorcontrib>IJspeert, Joep E G</creatorcontrib><creatorcontrib>Bossuyt, Patrick M M</creatorcontrib><creatorcontrib>Bleijenberg, Arne G C</creatorcontrib><creatorcontrib>van Leerdam, Monique E</creatorcontrib><creatorcontrib>van der Vlugt, Manon</creatorcontrib><creatorcontrib>Lansdorp-Vogelaar, Iris</creatorcontrib><creatorcontrib>Spaander, Manon C W</creatorcontrib><creatorcontrib>Dekker, Evelien</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The lancet. Gastroenterology & hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van Toledo, David E F W M</au><au>IJspeert, Joep E G</au><au>Bossuyt, Patrick M M</au><au>Bleijenberg, Arne G C</au><au>van Leerdam, Monique E</au><au>van der Vlugt, Manon</au><au>Lansdorp-Vogelaar, Iris</au><au>Spaander, Manon C W</au><au>Dekker, Evelien</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study</atitle><jtitle>The lancet. Gastroenterology & hepatology</jtitle><addtitle>Lancet Gastroenterol Hepatol</addtitle><date>2022-08</date><risdate>2022</risdate><volume>7</volume><issue>8</issue><spage>747</spage><epage>754</epage><pages>747-754</pages><issn>2468-1253</issn><eissn>2468-1253</eissn><abstract>Adenoma detection rate (ADR) is a well-established quality indicator for colonoscopy and is inversely associated with the incidence of interval post-colonoscopy colorectal cancer. However, interval post-colonoscopy colorectal cancers frequently develop from serrated polyps, which are not included in the ADR. Therefore, the proximal serrated polyp detection rate (PSPDR) has been proposed as a quality indicator, but its association with interval post-colonoscopy colorectal cancer has not been studied. We aimed to evaluate this potential association based on data collected in the Dutch colorectal cancer screening programme.
In this population-based study, using colonoscopy data from the Dutch faecal immunochemical test-based colorectal cancer screening programme and cancer data from the Netherlands Cancer Registry, we evaluated the association between endoscopists' individual PSPDR and their patients' risk of interval post-colonoscopy colorectal cancer with a shared frailty Cox proportional-hazard regression analysis. Participants in the screening programme who were eligible for inclusion were aged 55–76 years, had a positive faecal immunochemical test (cutoff 15 μg Hb/g faeces at start and changed mid-2014 to 47 μg Hb/g faeces), were asymptomatic, and underwent a colonoscopy between Jan 1, 2014, and Dec 31, 2020. The PSPDR was defined as the proportion of colonoscopies in which at least one serrated polyp proximal to the descending colon was detected, confirmed by histopathology. The ADR was defined as the proportion of all colonoscopies in which at least one conventional adenoma was detected, confirmed by histopathology. Detection rates were determined for each endoscopist individually. We additionally evaluated the risk of interval post-colonoscopy colorectal cancer for endoscopists with a PSPDR and ADR above the median versus endoscopists with either one or both parameters below the median. This study is registered with the Netherlands Trial Registry, NL8350.
During the study period, 329 104 colonoscopies were done, of which 277 555, done by 441 endoscopists, were included in the PSPDR calculations. The median PSPDR was 11·9% (IQR 8·3–15·8) and median ADR was 66·3% (61·4–69·9). The correlation between the PSDPR and ADR was moderate (r=0·59; p<0·0001). During a median follow-up of 33 months (IQR 21–42), 305 interval post-colonoscopy colorectal cancers were detected. For each percentage point increase in PSPDR, the adjusted interval post-colonoscopy colorectal cancer hazard was 7% lower (hazard ratio [HR] 0·93, 95% CI 0·90–0·95; p<0·0001). Compared with endoscopists with a PSPDR greater than 11·9% and ADR greater than 66·3%, the HR of interval post-colonoscopy colorectal cancer for endoscopists with a low PSPDR and high ADR was 1·79 (95% CI 1·22–2·63), for endoscopists with a high PSPDR and low ADR was 1·97 (1·19–3·24), and for endoscopists with a low PSPDR and low ADR was 2·55 (1·89–3·45).
The PSPDR of an endoscopist is inversely associated with the incidence of interval post-colonoscopy colorectal cancer. Implementation of PSPDR monitoring, in addition to ADR monitoring, could optimise colorectal cancer prevention.
None.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>35550250</pmid><doi>10.1016/S2468-1253(22)00090-5</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adenoma - diagnosis Adenoma - epidemiology Adenoma - pathology Colonic Polyps - diagnosis Colonic Polyps - epidemiology Colonic Polyps - pathology Colonoscopy Colorectal Neoplasms - diagnosis Colorectal Neoplasms - epidemiology Colorectal Neoplasms - pathology Early Detection of Cancer Humans |
| title | Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study |
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