Post-colonoscopy colorectal cancer: A population-based cohort study of fecal occult blood test-positive colonoscopies - 07/02/24
, Alice Bertolaso c, Isabelle Gendre b, d, Philippe Perrin b, d, Karima Hammas cHighlights |
• | PCCRC-3y prevalence was low, estimated at 2.4 %, in an organized population-based guaiac-based FOBT (gFOBT) CRC screening program. |
• | Most were true interval PCCRCs and were attributed to “possible missed lesion” and “likely incomplete resection”. |
• | The risk for PCCRC was higher among patients having their colonoscopy performed by a gastroenterologist with a cecal intubation rate <90 % and/or with an ADR <35 %. |
• | The mean absolute difference for ADR between gFOBT- and fecal immunochemical test (FIT)-positive colonoscopies was 16.3 %. |
• | We suggest that the minimum standard for ADR in gFOBT- and FIT-positive colonoscopies should be set at 35 % and 50 % to 55 % respectively, in the French screening program. |
Abstract |
Background |
Data on post-colonoscopy colorectal cancers (PCCRCs) after fecal occult blood test (FOBT)-positive colonoscopies is scarce (guaiac-based (gFOBT) or fecal immunochemical test (FIT)).
Aims |
Evaluate the prevalence and characteristics of PCCRCs in the French gFOBT CRC screening program.
Methods |
Retrospective population-based cohort study of all gFOBT-positive colonoscopies performed among individuals aged 50–74 between 2003 and 2014 within the CRC screening program organized in the Haut-Rhin (Alsace, France). The main outcome was PCCRC-3y rate. Adenoma detection rates (ADRs) calculated on gFOBT-positive colonoscopies were compared to those calculated on FIT-positive colonoscopies performed by the same gastroenterologists.
Results |
Overall, 9106 gFOBT-positive colonoscopies performed by 36 gastroenterologists were included. Sixteen PCCRC-3y and 31 PCCRC-5y were diagnosed (68.8 % and 58.1 % were true interval PCCRCs respectively). The unadjusted PCCRC-3y rate was 2.4 % [95 % confidence interval (CI) 1.4 %-3.9 %]. The risk for PCCRC-5y was significantly higher when the gastroenterologist's ADR was <35 % compared to ≥35 % (HR 2.17 [95 %CI 1.19–3.93]). The mean absolute difference for ADR between gFOBT- and FIT-positive colonoscopies was 16.3 % in favor of FIT-positive colonoscopies.
Conclusion |
PCCRC-3y prevalence was low, estimated at 2.4 %. We suggest that the minimum standard for ADR in gFOBT- and FIT-positive colonoscopies should be set at 35 % and 50 % to 55 % respectively, in the French screening program.
Le texte complet de cet article est disponible en PDF.Keywords : Colorectal neoplasms, Colonoscopy, Screening, Quality indicator, Fecal occult blood test
Abbreviations : ADR, BCSP, CI, CIR, CRC, ESGE, FIT, gFOBT, HR, IBD, IQR, PCCRC, PCCRC-3y, PCCRC-5y, SD, WEO
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Vol 48 - N° 2
Article 102285- février 2024 Retour au numéro
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