Miss rate for colorectal neoplastic polyps:: a prospective multicenter study of back-to-back video colonoscopies
Miss rate for colorectal neoplastic polyps:: a prospective multicenter study of back-to-back video colonoscopies
复制标题
DOI：
10.1055/s-2007-995618
复制
发表时间：
2008-04-01
期刊：
影响因子：
9.3
通讯作者：
Ponchan, T.
中科院分区：
文献类型：
--
作者：
Heresbach, D.;Barrioz, T.;Ponchan, T.
背景和研究目的：一些串联或连续的结肠镜检查研究已经计算了结肠镜检查期间息肉的漏诊率。我们的目标是评估腺瘤漏检率，同时限制技术或操作员专业知识偏差，即通过进行一项大型多中心研究，采用当天连续的视频结肠镜检查，由两名不同的操作员以随机顺序完成，并对其他检查不知情。 患者和方法：纳入了 11 个中心的 294 名患者。在 286 个可分析的串联结肠镜检查中，在基于病变和基于患者的分析中计算了漏诊率。这些比率中的每一个都是针对整体息肉、腺瘤、然后针对大于 5 毫米的病变和晚期腺瘤确定的。进行单变量和逻辑回归分析来定义与遗漏息肉或腺瘤相关的自变量。结果：息肉、腺瘤、息肉的遗漏率！ 5mm、>=5mm的腺瘤和晚期腺瘤分别为28%、20%、12%、9%和11%。没有漏掉任何具有癌性（n = 3）或类癌成分（n = 1）的肿块。息肉和腺瘤患者的特定病灶漏诊率分别为 36% 和 26%，但对所有 286 名患者进行计算时，相应的漏诊率分别为 23% 和 9.4%。息肉的直径（1 毫米增量）和数量（>= 3）与较低的息肉漏诊率独立相关，而无蒂或扁平形状以及左侧位置与较高的漏诊率显着相关。清洁的充分性、憩室的存在以及第一次手术退出的持续时间与腺瘤漏检率无关。结论：我们证实结肠镜检查期间息肉或腺瘤的漏检率很高。扁平息肉的检出是提高结肠镜检查质量必须重点关注的问题。
Background and study aim: Polyp miss rates during colonoscopy have been calculated in a few tandem or back-to-back colonoscopy studies. Our objective was to assess the adenoma miss rate while limiting technique or operator expertise biases, i.e. by performing a large multicenter study, with same-day back-to-back video colonoscopy, done by two different operators in randomized order and blinded to the other examination.Patients and methods: 294 patients at 11 centers were included. Among the 286 analyzable tandem colonoscopies, miss rates were calculated in both a lesion- and patient-based analysis. Each of these rates was determined for polyps overall, for adenomas, and then for lesions larger than 5 mm, and for advanced adenomas. Univariate and logistic regression analysis were performed to define independent variables associated with missed polyps or adenomas.Results: The miss rates for polyps, adenomas, polyps ! 5 mm, adenomas >= 5 mm, and advanced adenomas were, respectively, 28 %, 20 %,12 %, 9 % and 11 %. None of the masses with a carcinomatous (n = 3) or carcinoid component (n =1) was missed. The specific lesion miss rates for patients with polyps and adenomas were respectively 36% and 26% but the corresponding rates were 23% and 9.4% when calculated for all 286 patients. The diameter (1-mm increments) and number of polyps (>= 3) were independently associated with a lower polyp miss rate, whereas sessile or flat shape and left location were significantly associated with a higher miss rate. Adequacy of cleansing, presence of diverticula, and duration of withdrawal for the first procedure were not associated with adenoma miss rate.Conclusions: We confirm a significant miss rate for polyps or adenoma during colonoscopy. Detection of flat polyps is an issue that must be focused on to improve the quality of colonoscopy.