Adenoma detection rate after positive FIT associated with interval cancer risk
A Dutch study of fecal immunochemical testing (FIT)-based colonoscopies found that for every 1,000 patients, the expected number of cancers after five years would be about 2 for endoscopists with adenoma detection rates (ADRs) of 70%, compared with more than 4.5 with an ADR of 55%.
Higher adenoma detection rates (ADRs) are associated with lower risk for postcolonoscopy cancer, according to an analysis of fecal immunochemical testing (FIT)-based screening colonoscopies.
The population-based Dutch study was designed to assess the relationship between ADR and postcolonoscopy colorectal cancers (PCCRCs). It assessed 116,360 colonoscopies performed by 362 endoscopists based on positive FITs, with a median ADR of 67%. A total of 209 interval PCCRCs were identified. Results were published by Annals of Internal Medicine on Sept. 27.
Higher ADR was associated with lower risk of interval PCCRC, with an adjusted hazard ratio of 0.95 (95% CI, 0.92 to 0.97) per 1% increase in ADR. The study authors calculated that for every 1,000 patients undergoing colonoscopy, the expected number of PCCRC diagnoses after five years would be about 2 for endoscopists with ADRs of 70%, compared with more than 2.5, almost 3.5, and more than 4.5 for endoscopists with ADRs of 65%, 60%, and 55%, respectively.
The authors noted that although ADR is already an important quality indicator for endoscopists, “for colonoscopies done in FIT-positive screenees, the relationship with PCCRC is unclear, and no specific ADR target has been set.” The results of this study show that colonoscopy based on a positive FIT “demands a markedly higher ADR target than primary colonoscopy,” they wrote, adding that “endoscopists with lower ADRs can reduce the number of interval PCCRCs by 50% when increasing their ADR to the median.” Limitations of the study include the relative short duration of follow-up.
An accompanying editorial highlighted how the study “provides an excellent framework for evaluating 9 concepts regarding effective quality metrics and how these can illustrate pathways for meaningful metrics for the care of other cancers and disorders”: trustworthy, important, strategic, relevant, actionable, simple, gaming-resistant, time-stamped, and owned.
A recent “Beyond the Guidelines” feature in Annals of Internal Medicine discussed CRC screening. In the October edition, a primary care physician and a gastroenterologist discussed the recommendation to begin CRC screening at age 45 years, reviewed options for CRC screening, and analyzed how to choose among the available options. The article, which includes print, video, and educational components, was based on the Department of Medicine Grand Rounds conference held at Beth Israel Deaconess Medical Center on April 14.