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."
Brady
A P
AP
Department of Radiology, Wellesley Hospital, Toronto, Ontario, Canada.
Stevenson
G W
GW
Stevenson
I
I
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