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Area of Science:

  • Gastroenterology
  • Oncology
  • Public Health

Background:

  • Adenoma detection rate (ADR) is a key quality metric for colonoscopies in colorectal cancer (CRC) screening.
  • Data on ADRs in fecal immunochemical testing (FIT)-based screening are limited.
  • The link between ADR and postcolonoscopy CRC (PCCRC) in FIT screening needs further investigation.

Purpose of the Study:

  • To assess the association between ADR and the risk of interval PCCRC in colonoscopies performed after a positive FIT result.
  • To determine PCCRC incidence across different ADR levels in FIT-based screening.

Main Methods:

  • A population-based cohort study was conducted within the Dutch FIT-based CRC screening program.
  • Colonoscopies performed after a positive FIT result by accredited endoscopists were analyzed.
  • Multivariable Cox regression evaluated the association between ADR and interval PCCRC; incidence was calculated for various ADRs.

Main Results:

  • Over 116,000 colonoscopies by 362 endoscopists showed a median ADR of 67%.
  • A 1% increase in ADR was associated with a 5% reduction in interval PCCRC risk (aHR 0.95; 95% CI, 0.92-0.97).
  • Endoscopists with higher ADRs detected fewer interval PCCRCs, with significant differences observed at ADRs below 70%.

Conclusions:

  • Endoscopist ADR is inversely associated with interval PCCRC risk in FIT-positive colonoscopies.
  • Higher ADR targets are recommended for colonoscopies within FIT-based screening programs.
  • Improving ADR is essential for enhancing the effectiveness of CRC screening.