Research suggests need for separate detection benchmarks in determining colon cancer risk

Colorectal cancer is the third most common cancer in the world. Interval colorectal cancer, which is the development of colorectal cancer prior to the next recommended follow-up colonoscopy, makes up nine percent of all cases. Serrated polyps are important precursors for colorectal cancers but are indistinct and may be hard to detect. Interval colorectal cancers can result from low serrated polyp detection rate (SDR) and advanced adenomas detection rate (AADR) in medical centers. No benchmark for either SDR or AADR has been established.

After analyzing results from 3,513 colonoscopies from 26 gastroenterologists, a recent multi-center study published in Endoscopy compared the relationships between the adenoma detection rate (ADR), SDR, and AADR, and found that for patients with adequate ADR above 25 percent, the median SDR was 8.4 percent and AADR was 9.3 percent. “Interestingly, while all but one endoscopist had an adequate ADR above 25 percent, 23 percent of endoscopists had a low SDR, and 27 percent of endoscopists had a low AADR despite having an adequate ADR,” said principal investigator and clinical assistant professor Arvind Murali, MBBS. “ADR alone may not predict the SDR,” the study concludes, “and thus justifies the need for SDR as a quality indicator for colonoscopy.” The authors recognize that further clarification of the association between interval cancer and SDR and AADR will be needed to set benchmarks appropriately.

Murali worked with authors Alan Gunderson, MD, clinical assistant professor in Gastroenterology and Hepatology; Jagpal Klair, MBBS, recent graduate of UI’s gastroenterology fellowship; and Munish Ashat, MBBS, and Sumant Arora, MBBS, both current gastroenterology fellows, to analyze colonoscopy data from five US medical centers and to obtain the SDR and AADR.

Research teams from the University of Alabama-Birmingham, CHI Creighton University School of Medicine, Nebraska, University of Texas Medical Branch Galveston, and Medical Center Hospital, Odessa, contributed data to this study.

Murali was asked to provide a video commentary to accompany his team’s publication, presented below.

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