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Association Between Adenoma Detection Rate and Prevalent Colorectal Cancer Detection Rate in a National Colonoscopy
Jason A Dominitz1, Uri Ladabaum2, Jennifer L Holub3
1National Gastroenterology and Hepatology Program, Veterans Health Administration, Washington, District of Columbia; National Colorectal Cancer Screening Program, Veterans Health Administration, Washington, District of Columbia; Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
Higher adenoma detection rates (ADR) in colonoscopies correlate with increased detection of colorectal cancer (CRC). This suggests that ADR reflects both missed CRC and precancerous lesions, highlighting the importance of physician ADR for CRC prevention.
Area of Science:
- Gastroenterology
- Oncology
- Public Health
Background:
- Adenoma detection rate (ADR) is linked to postcolonoscopy colorectal cancer (CRC) risk.
- The extent to which ADR reflects missed CRC versus precancerous lesions remains unclear.
Purpose of the Study:
- To evaluate the association between physician ADR and the detection of prevalent CRC during colonoscopy.
Main Methods:
- Analysis of cross-sectional data from over 1.73 million colonoscopies (2019-2022) by 3567 endoscopists.
- Determination of endoscopist ADR and sessile serrated lesion detection rate (SSLDR) based on screening examinations.
Main Results:
- CRC detection increased with higher endoscopist ADR quintiles for both screening and follow-up colonoscopies.
- Higher ADR quintiles were associated with increased odds of CRC detection (OR 1.27-1.50).
- Low-ADR endoscopists showed lower CRC detection rates, irrespective of SSLDR.
Conclusions:
- Physician ADR reflects both CRC detection and the identification/removal of CRC precursors.
- Postcolonoscopy CRC may frequently result from missed CRC, particularly in endoscopists with low ADR.
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