Manuel Zorzi1, Carlo Senore2, Filippo Da Re3, Alessandra Barca4, Luigina Ada Bonelli5, Renato Cannizzaro6, Giovanni de Pretis7, Lucia Di Furia8, Emilio Di Giulio9, Paola Mantellini10, Carlo Naldoni11, Romano Sassatelli12, Douglas K Rex13, Marco Zappa14, Cesare Hassan15. 1. Veneto Tumour Registry, Regione Veneto, Padova, Italy. 2. CPO Piemonte and San Giovanni Battista University Hospital, Turin, Turin, Italy. 3. Settore promozione e sviluppo igiene e sanità pubblica, Regione Veneto, Venice, Italy. 4. Regione Lazio, Rome, Italy. 5. SS Prevenzione Secondaria e Screening, IRCCS AOU San Martino-IST, Genova, Italy. 6. Department of Oncological Gastroenterology, National Cancer Institute, IRCCS, Centro di Riferimento Oncologico, Aviano, PN, Italy. 7. U.O. multizonale di Gastroenterologia, Ospedale S. Chiara, Trento, Italy. 8. Agenzia Regionale Sanitaria, Regione Marche, Ancona, Italy. 9. Endoscopia Digestiva, Università di Roma 'Sapienza', Azienda Ospedaliera Sant'Andrea, Rome, Italy. 10. Clinical Epidemiology, Cancer Prevention and Research Institute (ISPO), Florence, Italy. 11. Assessorato alle politiche per la salute, Regione Emilia-Romagna, Bologna, Italy. 12. Unit of Gastroenterology and Digestive Endoscopy, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy. 13. Indiana University School of Medicine, Indiana University Hospital, Indianapolis, Indiana, USA. 14. SS Valutazione Screening, Cancer Prevention and Research Institute (ISPO), Florence, Italy. 15. Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
Abstract
OBJECTIVES: To assess detection rate and predictive factors of sessile serrated polyps (SSPs) in organised colorectal cancer (CRC) screening programmes based on the faecal immunochemical test (FIT). DESIGN: Data from a case series of colonoscopies of FIT-positive subjects were provided by 44 Italian CRC screening programmes. Data on screening history, endoscopic procedure and histology results, and additional information on the endoscopy centre and the endoscopists were collected, including the age-standardised and sex-standardised adenoma detection rate (ADR) of the individual endoscopists. The SSP detection rate (SSP-DR) was assessed for the study population. To identify SSP-predictive factors, multilevel analyses were performed according to patient/centre/endoscopist characteristics. RESULTS: We analysed 72 021 colonoscopies, of which 1295 presented with at least one SSP (SSP-DR 1.8%; 95% CI 1.7% to 1.9%). At the per-patient level, SSP-DR was associated with males (OR 1.35; 95% CI 1.17 to 1.54) and caecal intubation (OR 3.75; 95% CI 2.22 to 6.34), but not with the FIT round. The presence of at least one advanced adenoma was more frequent among subjects with SSPs than those without (OR 2.08; 95% CI 1.86 to 2.33). At the per-endoscopist level, SSP-DR was associated with ADR (third vs first ADR quartile: OR 1.55; 95% CI 1.03 to 2.35; fourth vs first quartile: OR 1.89; 95% CI 1.24 to 2.90). CONCLUSION: The low prevalence of SSPs and the lack of association with the FIT round argue against SSP as a suitable target for FIT-based organised programmes. Strict association of SSP-DR with the key colonoscopy quality indicators, namely caecal intubation rate and high ADR further marginalises the need for SSP-specific quality indicators in FIT-based programmes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVES: To assess detection rate and predictive factors of sessile serrated polyps (SSPs) in organised colorectal cancer (CRC) screening programmes based on the faecal immunochemical test (FIT). DESIGN: Data from a case series of colonoscopies of FIT-positive subjects were provided by 44 Italian CRC screening programmes. Data on screening history, endoscopic procedure and histology results, and additional information on the endoscopy centre and the endoscopists were collected, including the age-standardised and sex-standardised adenoma detection rate (ADR) of the individual endoscopists. The SSP detection rate (SSP-DR) was assessed for the study population. To identify SSP-predictive factors, multilevel analyses were performed according to patient/centre/endoscopist characteristics. RESULTS: We analysed 72 021 colonoscopies, of which 1295 presented with at least one SSP (SSP-DR 1.8%; 95% CI 1.7% to 1.9%). At the per-patient level, SSP-DR was associated with males (OR 1.35; 95% CI 1.17 to 1.54) and caecal intubation (OR 3.75; 95% CI 2.22 to 6.34), but not with the FIT round. The presence of at least one advanced adenoma was more frequent among subjects with SSPs than those without (OR 2.08; 95% CI 1.86 to 2.33). At the per-endoscopist level, SSP-DR was associated with ADR (third vs first ADR quartile: OR 1.55; 95% CI 1.03 to 2.35; fourth vs first quartile: OR 1.89; 95% CI 1.24 to 2.90). CONCLUSION: The low prevalence of SSPs and the lack of association with the FIT round argue against SSP as a suitable target for FIT-based organised programmes. Strict association of SSP-DR with the key colonoscopy quality indicators, namely caecal intubation rate and high ADR further marginalises the need for SSP-specific quality indicators in FIT-based programmes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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