Background

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.

Methods

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.

Findings

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).

Interpretation

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.

Funding

None.

中文翻译：

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锯齿状息肉检测和间隔期结肠镜检查后结直肠癌的风险：一项基于人群的研究

背景

腺瘤检出率 (ADR) 是结肠镜检查的公认质量指标，与结肠镜检查后间隔期结直肠癌的发病率呈负相关。然而，间歇性结肠镜检查后结直肠癌通常由锯齿状息肉发展而来，这不包括在 ADR 中。因此，近端锯齿状息肉检出率 (PSPDR) 已被提议作为质量指标，但其与结肠镜检查后间隔期结直肠癌的关联尚未得到研究。我们旨在根据荷兰结直肠癌筛查计划中收集的数据评估这种潜在关联。

方法

在这项基于人群的研究中，我们使用来自荷兰基于粪便免疫化学测试的结直肠癌筛查计划的结肠镜检查数据和来自荷兰癌症登记处的癌症数据，评估了内窥镜医师的个人 PSPDR 与患者结肠镜检查后间隔时间风险之间的关联结直肠癌与共享虚弱 Cox 比例风险回归分析。符合入选条件的筛查计划参与者年龄在 55-76 岁之间，粪便免疫化学测试呈阳性（开始时截断值为 15 μg Hb/g 粪便，2014 年年中变为 47 μg Hb/g 粪便），无症状，并在 2014 年 1 月 1 日至 2020 年 12 月 31 日期间接受了结肠镜检查。PSPDR 定义为在结肠镜检查中检测到至少一个靠近降结肠的锯齿状息肉的比例，经组织病理学证实。ADR 被定义为所有结肠镜检查中至少检测到一个常规腺瘤并经组织病理学证实的比例。每个内窥镜医师的检出率都是单独确定的。我们还评估了 PSPDR 和 ADR 高于中位数的内窥镜医师与其中一个或两个参数低于中位数的内窥镜医师之间间隔结肠镜检查后结直肠癌的风险。本研究已在荷兰试验登记处注册，NL8350。我们还评估了 PSPDR 和 ADR 高于中位数的内窥镜医师与其中一个或两个参数低于中位数的内窥镜医师之间间隔结肠镜检查后结直肠癌的风险。本研究已在荷兰试验登记处注册，NL8350。我们还评估了 PSPDR 和 ADR 高于中位数的内窥镜医师与其中一个或两个参数低于中位数的内窥镜医师之间间隔结肠镜检查后结直肠癌的风险。本研究已在荷兰试验登记处注册，NL8350。

发现

在研究期间，共进行了 329 104 次结肠镜检查，其中 441 名内镜医师进行的 277 555 次被纳入 PSPDR 计算。PSPDR 中位数为 11·9% (IQR 8·3–15·8)，ADR 中位数为 66·3% (61·4–69·9)。PSDPR 与 ADR 之间的相关性适中 (r=0·59；p<0·0001)。在 33 个月（IQR 21-42）的中位随访期间，检测到 305 例结肠镜检查后结直肠癌。PSPDR 每增加一个百分点，调整后的结肠镜检查后结直肠癌风险间隔降低 7%（风险比 [HR] 0·93，95% CI 0·90–0·95；p<0·0001）。与 PSPDR 大于 11·9% 和 ADR 大于 66·3% 的内镜医师相比，低 PSPDR 和高 ADR 的内镜医师在结肠镜检查后间隔期结直肠癌的 HR 为 1·79 (95% CI 1·22 –2·63),

解释

内窥镜医师的 PSPDR 与间隔期结肠镜检查后结直肠癌的发病率呈负相关。除了 ADR 监测外，实施 PSPDR 监测可以优化结直肠癌的预防。

资金

没有任何。