Quality Indicators for Colonoscopy and the Risk of Interval Cancer

Department of Gastroenterology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
New England Journal of Medicine (Impact Factor: 54.42). 05/2010; 362(19):1795-803. DOI: 10.1056/NEJMoa0907667
Source: PubMed

ABSTRACT Although rates of detection of adenomatous lesions (tumors or polyps) and cecal intubation are recommended for use as quality indicators for screening colonoscopy, these measurements have not been validated, and their importance remains uncertain.
We used a multivariate Cox proportional-hazards regression model to evaluate the influence of quality indicators for colonoscopy on the risk of interval cancer. Data were collected from 186 endoscopists who were involved in a colonoscopy-based colorectal-cancer screening program involving 45,026 subjects. Interval cancer was defined as colorectal adenocarcinoma that was diagnosed between the time of screening colonoscopy and the scheduled time of surveillance colonoscopy. We derived data on quality indicators for colonoscopy from the screening program's database and data on interval cancers from cancer registries. The primary aim of the study was to assess the association between quality indicators for colonoscopy and the risk of interval cancer.
A total of 42 interval colorectal cancers were identified during a period of 188,788 person-years. The endoscopist's rate of detection of adenomas was significantly associated with the risk of interval colorectal cancer (P=0.008), whereas the rate of cecal intubation was not significantly associated with this risk (P=0.50). The hazard ratios for adenoma detection rates of less than 11.0%, 11.0 to 14.9%, and 15.0 to 19.9%, as compared with a rate of 20.0% or higher, were 10.94 (95% confidence interval [CI], 1.37 to 87.01), 10.75 (95% CI, 1.36 to 85.06), and 12.50 (95% CI, 1.51 to 103.43), respectively (P=0.02 for all comparisons).
The adenoma detection rate is an independent predictor of the risk of interval colorectal cancer after screening colonoscopy.

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Available from: Joanna Didkowska, May 27, 2014
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    • "A study with 23-year follow-up found an ~53% mortality reduction in patients undergoing CS; a similar rate was found at 10 years in patients with and without adenomatous lesions (Zauber et al., 2012). CS requires specialized personnel: poor operator skill, partial examination, poor patient preparation and inadequate sedation are the main causes of failure and false negatives (Kaminski et al., 2010); successful examination with concomitant lesion removal reduces the risk of same-site recurrence (Brenner et al., 2013). CS screening is usually offered at 10-year intervals to individuals aged ≥50. "
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    Preventive Medicine 05/2014; 62. DOI:10.1016/j.ypmed.2014.02.010 · 2.93 Impact Factor
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    • "A large variation in colonoscopy practice among centres and endoscopists has been extensively reported, especially as concerns caecal intubation and polyp detection rates [1] [2] [3] [4] [5] [6] [7] [8]. As the sensitivity of colonoscopy for the diagnosis of colorectal tumours, and ultimately its effectiveness, is closely related to the quality of the examination [9] [10], the assessment of current practice and the benchmarking with quality standards has become a major issue in colonoscopy [11] [12]. At this purpose, the Italian Association of Hospital Gastroenterologists (AIGO) set up in year 2004 a nationwide survey of colonoscopy practice involving a broad sample of endoscopy centres throughout Italy, in order to provide information on the quality of colonoscopy in the " real life " , out of referral centres. "
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    • "f 1.28(1.08–1.51) f Kaminski et al. (2010) Poland (2000–2004) 45,026 42 0.093% 0.088% 0.105% 0.086% NR NR Baxter et al. (2011) Ontario (2000) (2001) (2002) (2003) (2004) (2005) "
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