title: Risk of advanced proximal neoplasms according to distal colorectal findings: comparison of sigmoidoscopy-based strategies.
abstract: BACKGROUND
  Screening for colorectal cancer with sigmoidoscopy benefits from the fact that distal findings predict the risk of advanced proximal neoplasms (APNs). This study was aimed at comparing the existing strategies of postsigmoidoscopy referral to colonoscopy in terms of accuracy and resources needed.
  
  
  METHODS
  Asymptomatic individuals aged 50-69 years were eligible for a randomized controlled trial designed to compare colonoscopy and fecal immunochemical test. Sigmoidoscopy yield was estimated from results obtained in the colonoscopy arm according to three sets of criteria of colonoscopy referral (from those proposed in the UK Flexible Sigmoidoscopy, Screening for COlon REctum [SCORE], and Norwegian Colorectal Cancer Prevention [NORCCAP] trials). Advanced neoplasm detection rate, sensitivity, specificity, and number of individuals needed to refer for colonoscopy to detect one APN were calculated. Logistic regression analysis was performed to identify distal findings associated with APN. All statistical tests were two-sided.
  
  
  RESULTS
  APN was found in 255 of 5059 (5.0%) individuals. Fulfillment of UK (6.2%), SCORE (12.0%), and NORCCAP (17.9%) criteria varied statistically significantly (P < .001). The NORCCAP strategy obtained the highest sensitivity for APN detection (36.9%), and the UK approach reached the highest specificity (94.6%). The number of individuals needed to refer for colonoscopy to detect one APN was 6 (95% confidence interval [CI] = 4 to 7), 8 (95% CI = 6 to 9), and 10 (95% CI = 8 to 12) when the UK, SCORE, and NORCCAP criteria were used, respectively. The logistic regression analysis identified distal adenoma ≥10 mm (odds ratio = 3.77; 95% CI = 2.52 to 5.65) as the strongest independent predictor of APN.
  
  
  CONCLUSIONS
  Whereas the NORCCAP criteria achieved the highest sensitivity for APN detection, the UK recommendations benefited from the lowest number of individuals needed to refer for colonoscopy.
authors.affiliation: Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Spain. castells@clinic.ub.es
authors.forename: Antoni
authors.initials: A
authors.lastname: Castells
authors.forename: Xavier
authors.initials: X
authors.lastname: Bessa
authors.forename: Enrique
authors.initials: E
authors.lastname: Quintero
authors.forename: Luis
authors.initials: L
authors.lastname: Bujanda
authors.forename: Joaquín
authors.initials: J
authors.lastname: Cubiella
authors.forename: Dolores
authors.initials: D
authors.lastname: Salas
authors.forename: Angel
authors.initials: A
authors.lastname: Lanas
authors.forename: Fernando
authors.initials: F
authors.lastname: Carballo
authors.forename: Juan Diego
authors.initials: JD
authors.lastname: Morillas
authors.forename: Cristina
authors.initials: C
authors.lastname: Hernández
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jover
authors.forename: Isabel
authors.initials: I
authors.lastname: Montalvo
authors.forename: Juan
authors.initials: J
authors.lastname: Arenas
authors.forename: Angel
authors.initials: A
authors.lastname: Cosme
authors.forename: Vicent
authors.initials: V
authors.lastname: Hernández
authors.forename: Begoña
authors.initials: B
authors.lastname: Iglesias
authors.forename: Inés
authors.initials: I
authors.lastname: Castro
authors.forename: Lucía
authors.initials: L
authors.lastname: Cid
authors.forename: Teresa
authors.initials: T
authors.lastname: Sala
authors.forename: Marta
authors.initials: M
authors.lastname: Ponce
authors.forename: Mercedes
authors.initials: M
authors.lastname: Andrés
authors.forename: Gloria
authors.initials: G
authors.lastname: Teruel
authors.forename: Antonio
authors.initials: A
authors.lastname: Peris
authors.forename: María-Pilar
authors.initials: MP
authors.lastname: Roncales
authors.forename: Francisca
authors.initials: F
authors.lastname: González-Rubio
authors.forename: Agustín
authors.initials: A
authors.lastname: Seoane-Urgorri
authors.forename: Jaume
authors.initials: J
authors.lastname: Grau
authors.forename: Anna
authors.initials: A
authors.lastname: Serradesanferm
authors.forename: Maria
authors.initials: M
authors.lastname: Pellisé
authors.forename: Akiko
authors.initials: A
authors.lastname: Ono
authors.forename: José
authors.initials: J
authors.lastname: Cruzado
authors.forename: Francisco
authors.initials: F
authors.lastname: Pérez-Riquelme
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Alonso-Abreu
authors.forename: Marta
authors.initials: M
authors.lastname: Carrillo-Palau
authors.forename: Mariola
authors.initials: M
authors.lastname: de la Vega-Prieto
authors.forename: Rosario
authors.initials: R
authors.lastname: Iglesias
authors.forename: Javier
authors.initials: J
authors.lastname: Amador
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Blanco
authors.forename: Rocío
authors.initials: R
authors.lastname: Sastre
authors.forename: Juan
authors.initials: J
authors.lastname: Ferrándiz
authors.forename: M José
authors.initials: MJ
authors.lastname: González-Hernández
authors.forename: Montserrat
authors.initials: M
authors.lastname: Andreu
mesh_terms: D017677:Age Distribution; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009780:Occult Blood; D016017:Odds Ratio; D011446:Prospective Studies; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D012812:Sigmoidoscopy; D013030:Spain / Q000453:epidemiology