Colonoscopist Adenoma Detection Rate Predicts Advanced Neoplasia Risk After Polypectomy
Douglas K. Rex, MD, MASGE, reviewing Gupta S, et al. Clin Gastroenterol Hepatol 2022 Oct 18.
Investigators evaluated 30,897 individuals with baseline polypectomy and at least 1 surveillance colonoscopy between 2004 and 2016 across 73 Veterans Administration sites in the U.S., with two-thirds assigned to a training cohort and one-third assigned to a validation cohort.
In the training set, clinical factors associated with an increased risk of metachronous advanced neoplasia included age (odds ratio [OR], 1.02 per 1-year increase), male gender (OR, 1.99), diabetes (OR, 1.41), current smoker (OR, 1.29), 3 or more adenomas, any adenoma ≥10 mm (OR, 1.54), and villous elements (OR, 1.31).
Adenoma detection rates (ADRs) were divided into 5 quintiles: quintile 1, ADR ≤19.7%; quintile 2, ADR 19.8% to 32.2%; quintile 3, ADR 32.3% to 39.3%; quintile 4, ADR 39.4% to 47%; and quintile 5, ADR >47%. Compared with quintile 5, quintiles 1, 2, and 3 were all associated with an increased risk of advanced neoplasia, with ORs of 1.48, 1.66, and 1.49, respectively. Quintiles 4 and 5 were not different with regard to the risk. Essentially all of these factors held up in the validation set, except male gender.
A model based on these factors produced modest improvements in sensitivity and specificity for advanced neoplasia, compared with the 2020 U.S. Multi-Society Task Force on Colorectal Cancer recommendations on postpolypectomy surveillance.
COMMENTThis study population was 97% male; therefore, quintile ADR levels would likely be lower in a mixed-gender patient population. These data indicate that ADR clearly contributes to advanced neoplasia risk after polypectomy. Compared with current guidelines, a model accounting for ADR and other clinical features improved performance, but incorporating the model into clinical practice could be difficult because of its complexity.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Gupta S, Earles A, Bustamante R, et al. Adenoma detection rate and clinical characteristics influence advanced neoplasia risk after colorectal polypectomy. Clin Gastroenterol Hepatol 2022 Oct 18. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2022.10.003)
