title: Improvable quality of diagnostic assessment of colorectal cancer in southern Netherlands.
abstract: OBJECTIVE
  To determine the extent of guideline implementation of the diagnostic approach in patients with colorectal cancer (CRC) in southern Netherlands in 2005, with special focus on colonoscopy.
  
  
  METHODS
  Data were extracted from the medical records for a random sample of 257 colon and 251 rectal cancer patients newly diagnosed in 2005 and recorded from the Eindhoven Cancer Registry. Adherence to guidelines was determined for diagnostic assessment. Multivariable logistic regression analysis was conducted to assess determinants of complete colonoscopy.
  
  
  RESULTS
  Diagnostic assessment was carried out mainly by internists (50%) and gastroenterologists (36%). Colonoscopy was performed in 83% of patients with proximal/transverse colon cancer, 55% of those with distal colon cancer, and 65% of those with rectal cancer. A tumour biopsy was taken for 84% of colon and 93% of rectal tumours. Colonoscopy completeness was lower for patients with comorbidity, obstructing tumours, and patients with poor bowel preparation. Abdominal ultrasound was performed for 72% of colon and 52% of rectal cancer patients and a thoracic radiography of over 80% of CRC patients. Computed tomography (CT) of the abdomen was performed in over half of the colon cancer patients and a pelvic CT scan or magnetic resonance imaging in 36% of rectal cancer patients.
  
  
  CONCLUSIONS
  Improvements in adherence to diagnostic guidelines for CRC appear possible, especially in the performance of imaging procedures. Among patients where complete visualization of the colon was not feasible with colonoscopy, imaging techniques such as virtual CT might be of added value in the near future.
authors.affiliation: Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven, The Netherlands. research@ikz.nl
authors.forename: Liza N
authors.initials: LN
authors.lastname: van Steenbergen
authors.forename: Valery E
authors.initials: VE
authors.lastname: Lemmens
authors.forename: Jan-Willem A
authors.initials: JW
authors.lastname: Straathof
authors.forename: Paul H
authors.initials: PH
authors.lastname: Nijhuis
authors.forename: Willem A
authors.initials: WA
authors.lastname: Gelderman
authors.forename: Jan-Willem W
authors.initials: JW
authors.lastname: Coebergh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000592:standards / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D010808:Physical Examination / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012042:Registries; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data