Background and Aims

Endoscopists who encounter an interval colorectal cancer (I-CRC) may be concerned about the implications because I-CRCs may represent a lapse in colonoscopy quality and a missed opportunity for prevention. We wanted to determine the I-CRC rate per colonoscopy examination and to examine the effect of colonoscopy volume and adenoma detection rate (ADR) on the number of I-CRCs attributable to an endoscopist.

Methods

We determined the rate of I-CRC diagnosis per outpatient colonoscopy examination by measuring the incidence of CRC diagnosis in practice and by assessing, via literature review, the percentage of cancers that are interval. We also estimated the number of attributable I-CRCs as a function of ADR and colonoscopy volume.

Results

Among 93,562 colonoscopies performed in 2013 to 2015 by 120 physicians in 4 diverse U.S. medical centers, 526 CRCs were diagnosed (.6%). Of 149,556 CRCs in the published literature, 7958 were I-CRCs (5.25% ± .94%). With rates of .6% (CRC per colonoscopy) and 5.25% (I-CRC per CRC), the rate of I-CRC is 1 per 3174 colonoscopies (95% confidence interval, 1 per 2710 to 1 per 3875). An endoscopist at the median of outpatient colonoscopy volume (316/year) in the lowest ADR quintile of detection (7%-19%) would have an I-CRC attributed every 8.2 years, or 4.2 I-CRCs in a 35-year career, versus every 16.7 years, or 2.0 I-CRCs in a 35-year career, for an endoscopist in the highest ADR quintile (33%-52%).

Conclusions

An average-volume endoscopist will have 2 to 4 attributable I-CRCs in a 35-year career, but the frequency will vary depending on colonoscopy volume and ADR.

中文翻译：

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在临床实践中归因于内镜医师的间隔性大肠癌发病率

背景和目标

遇到间隔性大肠癌（I-CRC）的内镜医师可能会担心这种影响，因为I-CRC可能代表结肠镜检查质量下降和错过的预防机会。我们想确定每次结肠镜检查的I-CRC率，并检查结肠镜检查的体积和腺瘤检出率（ADR）对内镜医师可归因的I-CRC数量的影响。

方法

我们通过在实践中测量CRC诊断的发生率，并通过文献综述评估间隔癌的百分比，来确定每次门诊结肠镜检查I-CRC诊断的比率。我们还估计了归因于I-CRC的数量与ADR和结肠镜检查量的关系。

结果

在2013年至2015年由美国4个不同医疗中心的120位医生进行的93562例结肠镜检查中，诊断出526例CRC（占6％）。在已出版的文献中的149,556个CRC中，有7958个是I-CRC（5.25％±.94％）。I.CRC的比率为0.6％（每个结肠镜检查的CRC）和5.25％（每个CRC的I-CRC），每3174个结肠镜检查的比率为1（95％置信区间，每2710个为1，每3875个为1）。内镜医师在门诊结肠镜检查量的中位数（316 /年）中发现的最低ADR五分位数（7％-19％）中，每隔8.2年应归因于I-CRC，而在35年的职业生涯中应归因于4.2次I-CRC ，对于ADR最高的五分之一（33％-52％）的内镜医师，则每35年的职业生涯中，每16.7年或2.0次I-CRC。

结论

在35年的职业生涯中，平均容量的内镜医师将拥有2至4个可归因的I-CRC，但频率会因结肠镜检查的容量和ADR而异。