Reasons for failure to diagnose colorectal carcinoma at colonoscopy
Reasons for failure to diagnose colorectal carcinoma at colonoscopy
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DOI：
10.1055/s-2004-814399
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发表时间：
2004-06-01
期刊：
影响因子：
9.3
通讯作者：
Frizelle, FA
中科院分区：
文献类型：
--
作者：
Leaper, M;Johnston, MJ;Frizelle, FA
背景和研究目的：结肠镜检查可能产生假阴性结果，其原因尚不清楚。这项研究的目的是研究为什么结肠镜检查会漏诊癌症。患者和方法：回顾性分析了43个月期间（1997年10月1日至2001年4月30日）在新西兰基督城医院进行的所有结肠镜检查（数据是前瞻性收集的）。还确定了1997年10月1日至2001年7月30日期间（延长3个月，以获得延迟诊断）的所有结直肠癌病例。然后比较两个数据库，并确定和分析所有在病理科收到结直肠癌标本前6周以上进行结肠镜检查的病例。结果：4598例患者共进行了5055次结肠镜检查。在此期间，病理数据库中发现了630例结直肠癌;其中286例受影响的患者在结肠镜检查和病理数据库中。66例患者在诊断结直肠癌前6周以上进行了结肠镜检查。在这66名患者中，有48名被确定为癌症，并正在提供治疗。17例癌症（5.9%）在结肠镜检查中被遗漏，其中9例患者的结肠镜检查不完整。在17例中的7例中，记录了替代良性原因。在4名患者中，发现病变并认为是良性的，但随后被证明不是。在另外4例病例中，尽管进行了充分的肠道准备，结肠镜医生认为结肠镜检查充分，但癌症仍未被诊断出来。结论：286例癌症中，结肠镜检查漏诊17例（5.9%）。漏诊癌症的原因与结肠镜检查不完整、肠道准备不充分、对所见内容的误解、未能对所见病变进行充分的活检（和随访）以及与结肠镜检查不完整患者的随访检查相关的系统故障有关。结肠镜检查和钡灌肠检查可能无法诊断癌症，这一事实具有重要的法医学意义。结肠镜检查可能漏诊癌症的认识应该鼓励医生在临床和调查结果之间缺乏相关性时重新调查患者。
Background and Study Aims: Colonoscopy can produce false-negative results, and the reasons for this remain obscure. The aim of this study was to examine why cancers are missed at colonoscopy. Patients and Methods: All colonoscopies carried out at Christchurch Hospital, New Zealand, over a 43-month period (1 October 1997-30 April 2001) were retrospectively analyzed (the data having been prospectively collected). All cases of colorectal carcinoma during the period 1 October 1997-30 July 2001 (3 months longer, to capture delayed diagnoses) were also identified. The two databases were then compared, and all cases in which a colonoscopy had been performed more than 6 weeks before a colorectal carcinoma specimen being received by the pathology department were identified and analyzed. Results: A total of 5055 colonoscopies were undertaken in 4598 patients. Over this period, 630 colorectal carcinomas were identified in the pathology database; 286 of the patients affected were in the colonoscopy and pathology database. Sixty-six patients had had a colonoscopy performed more than 6 weeks before the diagnosis of colorectal carcinoma. Carcinoma was identified in 48 of these 66 patients, and management was being provided. Seventeen cancers (5.9%) were missed at colonoscopy, and the patients had had an incomplete colonoscopy in nine of these cases. In seven of the 17, an alternative benign cause was recorded. In four patients, a lesion was seen and thought to be benign, although subsequently proven not to be. In another four cases, the cancer was not diagnosed despite adequate bowel preparation and what was thought by the colonoscopist to be an adequate colonoscopy. Conclusions: Colonoscopy missed 17 of 286 cancers (5.9%). The reasons why cancers were missed relate to incomplete colonoscopy, poor bowel preparation, misinterpretation of what was seen, failure to carry out adequate biopsy (and follow-up) of lesions seen, and systems failures related to follow-up investigations in patients who had an incomplete colonoscopy. The fact that colonoscopy and barium enema investigations may fail to diagnose cancers has important medicolegal implications. The recognition that colonoscopy may miss a cancer should encourage doctors to reinvestigate patients when there is a lack of correlation between the clinical and investigative findings.