DOI: http://dx.doi.org/10.18203/2349-2902.isj20194150

Colonoscopic miss rate for colorectal cancer: a district general hospital experience

Anne Macleod, Peshang Abdulhannan, Julie Walker, Tracy Wood, John Painter, Michael Kipling

Abstract


Background: The aim of the study was to review our post-colonoscopy colorectal cancer (PCCRC) diagnoses rate and compare it to national standards, to identify any common factors in our missed cancer cases and create a policy for capturing missed cancers data.

Methods: We analyzed retrospectively collected data on patients with colorectal cancer from January 2015 to July 2017. Patients who had a previous colonoscopy within 3 years of diagnosis were then identified. We excluded colonoscopies done within 6 weeks of diagnosis or repeat colonoscopies due to poor bowel preparation.

Results: 503 colorectal cancer patients were identified. 135 (26.8%) were initially diagnosed without a lower GI endoscopy. 30 had a negative colonoscopy 6 weeks to 3 years prior to diagnosis. Only 10 patients (2.7%) were true missed lesions (false negative colonoscopy). Male/female: 5/5. Mean age was 68.4 (49-80). 9 patients had good or satisfactory bowel preparation. 50% of lesions were found during follow-up or treatment of a different lesion. Average time from false negative scope to diagnosis was 20.3 months (4-31). Sites of missed lesions are left colon- 4, low rectum- 3, caecum- 2 and transverse colon- 1.

Conclusions: Our PCCRC rate is below the GUT recommended target of <5% and well below the national average 8.5%. We identified no common features across all missed cases. Contrary to other published data, right sided lesions were less common with no female predominance. We recognize the limitations of access to only local trust data. We propose to monitor PCCRC rate annually, present this at clinical governance meetings and review each case individually as an adverse event.


Keywords


Colonoscopy, Colon cancer, Miss rate, Missed cancer

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References


Cancer Research UK. Bowel cancer statistics 2016. Available at: http://www.cancerresearchuk.org/ cancer-info/cancerstats/types/bowel/. Accessed on 10 July 2019.

National Cancer Intelligence Network. Colorectal cancer survival by stage 2013. Available at: http://www.ncin.org.uk/publications/data_briefings/colorectal_cancer_survival_by_stage. Accessed on 10 July 2019.

Rex DK, Cutler CS, Lemmel GT, Rahmani EY, Clark DW, Helper DJ, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterol. 1997;112:24-8

Morris EJ, Sandin F, Lambert PC, Bray F, Klint A, Linklater K, et al. A population-based comparison of the survival of patients with colorectal cancer in England, Norway and Sweden between 1996 and 2004. Gut. 2011;60(8):1087-93.

Robertson DJ, Greenberg ER, Beach M, Sandler RS, Ahnen D, Haile RW, et al. Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterol. 2005;129:34-41.

Farrar WD, Sawhney MS, Nelson DB, Lederle FA, Bond JH. Colorectal cancers found after a complete colonoscopy. Clin Gastroenterol Hepatol. 2006;4:1259-64.

Kaminski MF, Regula J, Kraszewska E, Polkowski M, Wojciechowska U, Didkowska J, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010;362:1795-803.

Forsberg A, Hammar U, Ekbom A, Hultcrantz R. Post-colonoscopy colorectal cancers in Sweden: room for quality improvement. Europ J Gastroenterol Hepatol. 2017;29(7):855-60.

Rees CJ, Gibson ST, Rutter MD, Baragwanath P, Pullan R, Feeney M, et al. UK key performance indicators and quality assurance standards for colonoscopy. Gut. 2016;65:1923-9.

Benedict M, Neto AG, Zhang X. Interval colorectal carcinoma: an unsolved debate. World J Gastroenterol. 2015;21(45):12735-41.

Singh H, Nugent Z, Demers AA, Bernstein CN. Rate and predictors of early or missed colorectal cancers after colonoscopy in Manitoba: a population based study. Am J Gastroenterol. 2010;105:2588-96.

Morris EJA, Rutter MD, Finan PJ, Thomas JD, Valori R. Post-colonoscopy colorectal cancer (PCCRC) rates vary considerably depending on the method used to calculate them: a retrospective observational population-based study of PCCRC in the English National Health Service. Gut. 2015;64(8):1248-56.

Simon K. Colorectal cancer development and advances in screening. Clin Interven Aging. 2016;11:967-76.

Lee YM, Huh KC. Clinical and biological features of interval colorectal cancer. Clin Endoscop. 2017;50(3):254-60.

le Clercq CM, Bouwens MW, Rondagh EJ, Bakker CM, Keulen ET, de Ridder RJ, et al. Post colonoscopy colorectal cancers are preventable: a population-based study. Gut. 2014;63:957-63.

Bressler B, Paszat LF, Chen Z, Rothwell DM, Vinden C, Rabeneck L. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterol. 2007;132:96-102.

Cooper GS, Xu F, Sloan BJS, Schluchter MD, Koroukian SM. Prevalence and predictors of interval cancers in Medicare beneficiaries. Cancer. 2012;118:3044-52.

Leufkens AM, van Oijen MG, Vleggaar FP, Siersema PD. Factors influencing the miss rate of polyps in a back-to-back colonoscopy study. Endoscop. 2012;44:470-5.