title: Measurement of adenoma detection and discrimination during colonoscopy in routine practice: an exploratory study.
abstract: BACKGROUND
  Measuring neoplasia yield is a priority in the quality improvement process for colonoscopy. However, neither the most appropriate quality indicator nor the standard threshold has been established.
  
  
  OBJECTIVE
  To determine the most appropriate quality indicators to assess the yield of routine colonoscopy.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Population-based colorectal cancer screening program in 3 French administrative areas.
  
  
  METHODS
  One hundred gastroenterologists and their average-risk asymptomatic patients aged 50 to 74 years undergoing colonoscopy for positive guaiac-based fecal occult blood test results.
  
  
  METHODS
  Comparison of several indicators, mainly the adenoma detection rate (ADR) and polyp detection rate (PDR), the mean number of adenomas per colonoscopy (MNA) and mean number of polyps (MNP) and the proportion of adenomas among polyps (PAP).
  
  
  RESULTS
  Correlations were good between the ADR and PDR (Pearson coefficient r = 0.88 [95% CI, 0.78-0.94]) and between MNA and MNP (r = 0.89 [95% CI, 0.79-0.94]) (P < .0001 for both). Gastroenterologists were classified as higher or lower detectors in comparison with the lower limit of the 95% confidence interval of the median value for each indicator. The MNP (MNA) provided better discrimination than the PDR (ADR). Concordance between classifications of gastroenterologists according to their MNA and MNP was excellent (κ = 0.89). PAP varied dramatically from 38% to 95% between gastroenterologists and was very poorly correlated with the ADR (r = -0.27 [95% CI, -0.54 to 0.07; P = .11]) and the MNA (r = 0.03 [95% CI, -0.29 to 0.36; P = .88]).
  
  
  CONCLUSIONS
  Some factors influencing the neoplasia yield were not taken into account.
  
  
  CONCLUSIONS
  The MNP could replace the ADR for the assessment of adenoma detection in routine practice. A separate indicator, PAP, would be necessary to assess adenoma discrimination ability.
authors.affiliation: Médecine A, Hôpital Pasteur, Colmar, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Denis
authors.forename: Erik André
authors.initials: EA
authors.lastname: Sauleau
authors.forename: Isabelle
authors.initials: I
authors.lastname: Gendre
authors.forename: Christine
authors.initials: C
authors.lastname: Piette
authors.forename: Jean François
authors.initials: JF
authors.lastname: Bretagne
authors.forename: Philippe
authors.initials: P
authors.lastname: Perrin
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000453:epidemiology; D000368:Aged; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer / Q000379:methods*; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies