Adenoma Detection Rate Linked to Colorectal Cancer Risk after Positive FIT

The adenoma detection rate (ADR) after a positive fecal immunochemical test (FIT) was found to be inversely related to the risk of developing interval postcolonoscopy colorectal cancers (PCCRC), according to a study published in the Annals of Internal Medicine.

“The ADR is an essential quality indicator for endoscopists performing colonoscopies for colorectal cancer (CRC) screening as it is associated with PCCRCs. Currently, data on ADRs of endoscopists performing colonoscopies in FIT-based screening, the most common screening method, are scarce. Also, the association between the ADR and PCCRC has not been demonstrated in this setting,” the investigators from Netherlands explained.

PCCRCs were classified as interval, in which a cancer was detected before recommended surveillance, or noninterval, the report read. Out of the 116,360 colonoscopies, with a median ADR of 67%, the investigators identified 209 interval PCCRCs. The study found that “for every 1000 patients undergoing colonoscopy, the expected number of interval PCCRC diagnoses after 5 years was approximately 2 for endoscopists with ADRs of 70%, compared with more than 2.5, almost 3.5, and more than 4.5 for endoscopists with ADRs of 65%, 60%, and 55%, respectively.”

Based on these findings, the authors concluded, “Endoscopists performing colonoscopy in FIT-based screening should aim for markedly higher ADRs compared with primary colonoscopy.”

—Priyam Vora

Reference:
Wisse P, Erler N, Boer S et al. Adenoma detection rate and risk for interval postcolonoscopy colorectal cancer in fecal immunochemical test-based screening: a population-based cohort study. Ann Intern Med. Published Online: September 27, 2022. DOI: 10.7326/M22-0301