OBJECTIVE: Some individuals are diagnosed with colorectal cancer (CRC) despite recent colonoscopy. We examined individuals under colonoscopic surveillance for colonic adenomas to assess possible reasons for diagnosing cancer after a recent colonoscopy with complete removal of any identified polyps. DESIGN: Primary data were pooled from eight large (>800 patients) North American studies in which participants with adenoma(s) had a baseline colonoscopy (with intent to remove all visualised lesions) and were followed with subsequent colonoscopy. We used an algorithm based on the time from previous colonoscopy and the presence, size and histology of adenomas detected at prior exam to assign interval cancers as likely being new, missed, incompletely resected (while previously an adenoma) or due to failed biopsy detection. RESULTS: 9167 participants (mean age 62) were included in the analyses, with a median follow-up of 47.2 months. Invasive cancer was diagnosed in 58 patients (0.6%) during follow-up (1.71 per 1000 person-years follow-up). Most cancers (78%) were early stage (I or II); however, 9 (16%) resulted in death from CRC. We classified 30 cancers (52%) as probable missed lesions, 11 (19%) as possibly related to incomplete resection of an earlier, non-invasive lesion and 14 (24%) as probable new lesions. The cancer diagnosis may have been delayed in three cases (5%) because of failed biopsy detection. CONCLUSIONS: Despite recent colonoscopy with intent to remove all neoplasia, CRC will occasionally be diagnosed. These cancers primarily seem to represent lesions that were missed or incompletely removed at the prior colonoscopy and might be avoided by increased emphasis on identifying and completely removing all neoplastic lesions at colonoscopy.
OBJECTIVE: Some individuals are diagnosed with colorectal cancer (CRC) despite recent colonoscopy. We examined individuals under colonoscopic surveillance for colonic adenomas to assess possible reasons for diagnosing cancer after a recent colonoscopy with complete removal of any identified polyps. DESIGN: Primary data were pooled from eight large (>800 patients) North American studies in which participants with adenoma(s) had a baseline colonoscopy (with intent to remove all visualised lesions) and were followed with subsequent colonoscopy. We used an algorithm based on the time from previous colonoscopy and the presence, size and histology of adenomas detected at prior exam to assign interval cancers as likely being new, missed, incompletely resected (while previously an adenoma) or due to failed biopsy detection. RESULTS: 9167 participants (mean age 62) were included in the analyses, with a median follow-up of 47.2 months. Invasive cancer was diagnosed in 58 patients (0.6%) during follow-up (1.71 per 1000 person-years follow-up). Most cancers (78%) were early stage (I or II); however, 9 (16%) resulted in death from CRC. We classified 30 cancers (52%) as probable missed lesions, 11 (19%) as possibly related to incomplete resection of an earlier, non-invasive lesion and 14 (24%) as probable new lesions. The cancer diagnosis may have been delayed in three cases (5%) because of failed biopsy detection. CONCLUSIONS: Despite recent colonoscopy with intent to remove all neoplasia, CRC will occasionally be diagnosed. These cancers primarily seem to represent lesions that were missed or incompletely removed at the prior colonoscopy and might be avoided by increased emphasis on identifying and completely removing all neoplastic lesions at colonoscopy.
Authors: Wendy S Atkin; Rob Edwards; Ines Kralj-Hans; Kate Wooldrage; Andrew R Hart; John M A Northover; D Max Parkin; Jane Wardle; Stephen W Duffy; Jack Cuzick Journal: Lancet Date: 2010-04-27 Impact factor: 79.321
Authors: María Elena Martínez; John A Baron; David A Lieberman; Arthur Schatzkin; Elaine Lanza; Sidney J Winawer; Ann G Zauber; Ruiyun Jiang; Dennis J Ahnen; John H Bond; Timothy R Church; Douglas J Robertson; Stephanie A Smith-Warner; Elizabeth T Jacobs; David S Alberts; E Robert Greenberg Journal: Gastroenterology Date: 2008-12-09 Impact factor: 22.682
Authors: Nancy N Baxter; Meredith A Goldwasser; Lawrence F Paszat; Refik Saskin; David R Urbach; Linda Rabeneck Journal: Ann Intern Med Date: 2008-12-15 Impact factor: 25.391
Authors: Keith Leung; Paul Pinsky; Adeyinka O Laiyemo; Elaine Lanza; Arthur Schatzkin; Robert E Schoen Journal: Gastrointest Endosc Date: 2009-07-31 Impact factor: 9.427
Authors: David A Lieberman; David G Weiss; William V Harford; Dennis J Ahnen; Dawn Provenzale; Stephen J Sontag; Thomas G Schnell; Gregorio Chejfec; Donald R Campbell; Jayashri Kidao; John H Bond; Douglas B Nelson; George Triadafilopoulos; Francisco C Ramirez; Judith F Collins; Tiina K Johnston; Kenneth R McQuaid; Harinder Garewal; Richard E Sampliner; Romeo Esquivel; Douglas Robertson Journal: Gastroenterology Date: 2007-10 Impact factor: 22.682
Authors: Bernard Levin; David A Lieberman; Beth McFarland; Robert A Smith; Durado Brooks; Kimberly S Andrews; Chiranjeev Dash; Francis M Giardiello; Seth Glick; Theodore R Levin; Perry Pickhardt; Douglas K Rex; Alan Thorson; Sidney J Winawer Journal: CA Cancer J Clin Date: 2008-03-05 Impact factor: 508.702
Authors: Amandeep K Shergill; Erin E Conners; Kenneth R McQuaid; Sara Epstein; James C Ryan; Janak N Shah; John Inadomi; Ma Somsouk Journal: Gastrointest Endosc Date: 2015-05-01 Impact factor: 9.427
Authors: A Tannapfel; D Aust; G B Baretton; H Bläker; I Esposito; C Langner; M Vieth; E Wardelmann; Th Kirchner; P Schirmacher Journal: Pathologe Date: 2015-03 Impact factor: 1.011
Authors: Sahana Arumugam; Chantal M C le Clercq; Robert G Riedl; Ad A M Masclee; Silvia Sanduleanu Journal: Am J Gastroenterol Date: 2015-01 Impact factor: 10.864
Authors: Michal F Kaminski; Siwan Thomas-Gibson; Marek Bugajski; Michael Bretthauer; Colin J Rees; Evelien Dekker; Geir Hoff; Rodrigo Jover; Stepan Suchanek; Monika Ferlitsch; John Anderson; Thomas Roesch; Rolf Hultcranz; Istvan Racz; Ernst J Kuipers; Kjetil Garborg; James E East; Maciej Rupinski; Birgitte Seip; Cathy Bennett; Carlo Senore; Silvia Minozzi; Raf Bisschops; Dirk Domagk; Roland Valori; Cristiano Spada; Cesare Hassan; Mario Dinis-Ribeiro; Matthew D Rutter Journal: United European Gastroenterol J Date: 2017-03-16 Impact factor: 4.623