Detection Measures Other Than Adenoma Detection Rate Predict Postcolonoscopy Cancer
Douglas K. Rex, MD, MASGE, reviewing Wieszczy P, et al. Clin Gastroenterol Hepatol 2022 Mar 24.
The adenoma detection rate (ADR) predicts the incidence of interval cancer after colonoscopy. Although ADR correlates in retrospective studies with other detection measures, it is unclear whether other detection measures predict the risk of postcolonoscopy colorectal cancer (PCCRC).
In this study of 173,287 patients and 262 endoscopists from Poland, 395 PCCRCs were detected during a median follow-up of 10 years. This study examined multiple detection measures, including ADR, polyp detection rate (PDR), advanced adenoma detection rate (AADR), adenomas per colonoscopy (APC), and adenomas per positive colonoscopy (APPC). The prevalence of sessile serrated lesions was <1%, and they were counted as adenomas. ADR was highly correlated with PDR and APC and moderately correlated with AADR and APPC.
ADR, PDR, and APC were each strongly and similarly associated with reduced risk of PCCRC and colorectal cancer mortality. AADR and APPC did not have as strong a correlation with colorectal cancer prevention.
COMMENTThese are important data because they show other detection measures beyond ADR that correlate with cancer prevention. Limitations include the relatively low ADRs, with the highest quintile at ≥25%, whereas the average ADR in the U.S. is currently 40%. The very low prevalence of sessile serrated lesions also raises concerns about detection. Nevertheless, the data suggest that PDR and APC could both be used as alternatives to ADR. APC is a more complicated measure than ADR and, in this study, appeared to offer no advantages. PDR is clearly simpler to measure than ADR, but there is still the risk in prospective use that it might lead to gaming through resection of diminutive rectosigmoid hyperplastic polyps.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Wieszczy P, Bugajski M, Januszewicz W, et al. Comparison of quality measures for detection of neoplasia at screening colonoscopy. Clin Gastroenterol Hepatol 2022 Mar 24. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2022.03.023)
