Colorectal cancer overlooked at barium enema examination and colonoscopy: a continuing perceptual problem.
OBJECTIVE
To evaluate reasons for missed diagnosis of colorectal carcinoma at barium enema (BE) examination and colonoscopy and determine if standards have improved since a similar study in 1981.


METHODS
Relevant studies obtained within 3 years of diagnosis in 161 patients with colorectal carcinoma treated in 1990 were reviewed.


RESULTS
Twenty-seven carcinomas were overlooked at BE examination and seven at colonoscopy. Fifteen percent of BE examination errors were purely perceptive (ie, the tumor was visible in retrospect). Another 15% were purely technical. Combined perceptive and technical errors occurred in 45% of cases. Interpretive errors (ie, the lesion was misinterpreted as benign) occurred in 25% of cases.


CONCLUSIONS
Similar reasons for missing diagnoses of colorectal cancer at BE examination were seen in 1990 and 1981, with a high rate of perceptive errors. Double reading BE studies may reduce this rate, and readiness to perform BE examination after an incomplete colonoscopy may reduce colonoscopic "misses."
Department of Radiology, Wellesley Hospital, Toronto, Ontario, Canada.
A P
AP
Brady
G W
GW
Stevenson
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I
Stevenson
D001466:Barium Sulfate; D003106:Colon / Q000000981:diagnostic imaging; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003951:Diagnostic Errors; D004733:Enema; D006801:Humans; D011859:Radiography; D012007:Rectum / Q000000981:diagnostic imaging; D012189:Retrospective Studies
D001466:Barium Sulfate