Article
Adenoma Miss Rate of Conventional Colonoscopy: a Systematic Review and Meta-Analysis
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Authors
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Marvin Bundo
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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Beate Jahn
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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Marjan Arvandi
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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Gaby Sroczynski
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
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Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria; Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| Published: | March 6, 2018 |
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Outline
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Background: Conventional colonoscopy (CC) continues to be the most frequently used technology for colorectal cancer (CRC) screening in the general population, but colorectal adenomas could be missed by this procedure. The adenoma miss rate (AMR) is of important clinical significance, as the removal of adenomas can contribute to risk reduction for CRC and related mortality. Tandem colonoscopy is considered the most reliable method for evaluating AMR. Meta-analyses summarizing recent evidence from RCTs on AMR of CC are missing. We aimed at obtaining a pooled estimate for AMR (prob-AMR) with 95% confidence interval (95%CI) of CC as determined by tandem colonoscopy RCTs.
Methods: We systematically searched in PubMed, Embase and Cochrane Library. We included randomized same-day tandem colonoscopy studies with cross-over design, comparing CC to novel colonoscopy technologies (NCTs) in patients undergoing screening and surveillance colonoscopy. Our primary endpoint was AMR of CC, that is, adenomas missed during the first examination with CC and found during a second look with NCTs. We conducted random effects meta-analyses using a generalized linear mixed model approach. Likelihood ratio tests (LRT), I2 statistics and meta-regressions were used to address heterogeneity. Subgroup analyses were performed to evaluate AMR by size and histology.
Results: Eleven studies with a total of 1,314 patients were included. In most of the studies, quality-adjusted colonoscopy was performed. The overall prob-AMR was 34% (95%CI: 28-40%). Subgroup analyses showed prob-AMRs (1) by size (seven studies; 952 patients): 37% (95%CI: 32-43%) for 1-5 mm, 28% (95%CI: 20-39%) for 6-9 mm and 12% (95%CI: 7-20%) for ≥10 mm adenomas; (2) by histology (6 studies; 582 patients): 41% (95%CI: 36-48%) for non-advanced and 19% (95%CI: 11-30%) for advanced adenomas. There was substantial and statistically significant heterogeneity (I2 = 80%, LRT: p< 0.0001). However, none of the assessed covariates (including: prevalence, indication, NCT type) explained heterogeneity.
Conclusion: Based on our meta-analysis, one in three adenomas could be missed by CC. This estimate may not perfectly reflect clinical practice because the comparators used for our study (NCTs) are no perfect gold standard and the included studies are conducted under artificial conditions. However, our study suggests that AMR remains high even with a quality-adjusted CC. Therefore, further research on NCTs should be considered.
