title: Detection rate and predictive factors of sessile serrated polyps in an organised colorectal cancer screening programme with immunochemical faecal occult blood test: the EQuIPE study (Evaluating Quality Indicators of the Performance of Endoscopy).
abstract: To assess detection rate and predictive factors of sessile serrated polyps (SSPs) in organised colorectal cancer (CRC) screening programmes based on the faecal immunochemical test (FIT).
  
  
  
  Data from a case series of colonoscopies of FIT-positive subjects were provided by 44 Italian CRC screening programmes. Data on screening history, endoscopic procedure and histology results, and additional information on the endoscopy centre and the endoscopists were collected, including the age-standardised and sex-standardised adenoma detection rate (ADR) of the individual endoscopists. The SSP detection rate (SSP-DR) was assessed for the study population. To identify SSP-predictive factors, multilevel analyses were performed according to patient/centre/endoscopist characteristics.
  
  
  
  We analysed 72 021 colonoscopies, of which 1295 presented with at least one SSP (SSP-DR 1.8%; 95% CI 1.7% to 1.9%). At theper-patientlevel, SSP-DR was associated with males (OR 1.35; 95% CI 1.17 to 1.54) and caecal intubation (OR 3.75; 95% CI 2.22 to 6.34), but not with the FIT round. The presence of at least one advanced adenoma was more frequent among subjects with SSPs than those without (OR 2.08; 95% CI 1.86 to 2.33). At theper-endoscopistlevel, SSP-DR was associated with ADR (third vs first ADR quartile: OR 1.55; 95% CI 1.03 to 2.35; fourth vs first quartile: OR 1.89; 95% CI 1.24 to 2.90).
  
  
  
  The low prevalence of SSPs and the lack of association with the FIT round argue against SSP as a suitable target for FIT-based organised programmes. Strict association of SSP-DR with the key colonoscopy quality indicators, namely caecal intubation rate and high ADR further marginalises the need for SSP-specific quality indicators in FIT-based programmes.
authors.affiliation: Veneto Tumour Registry, Regione Veneto, Padova, Italy.
authors.forename: Manuel
authors.initials: M
authors.lastname: Zorzi
authors.affiliation: CPO Piemonte and San Giovanni Battista University Hospital, Turin, Turin, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Senore
authors.affiliation: Settore promozione e sviluppo igiene e sanità pubblica, Regione Veneto, Venice, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Da Re
authors.affiliation: Regione Lazio, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Barca
authors.affiliation: SS Prevenzione Secondaria e Screening, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Luigina Ada
authors.initials: LA
authors.lastname: Bonelli
authors.affiliation: Department of Oncological Gastroenterology, National Cancer Institute, IRCCS, Centro di Riferimento Oncologico, Aviano, PN, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Cannizzaro
authors.affiliation: U.O. multizonale di Gastroenterologia, Ospedale S. Chiara, Trento, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Pretis
authors.affiliation: Agenzia Regionale Sanitaria, Regione Marche, Ancona, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Di Furia
authors.affiliation: Endoscopia Digestiva, Università di Roma 'Sapienza', Azienda Ospedaliera Sant'Andrea, Rome, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Di Giulio
authors.affiliation: Clinical Epidemiology, Cancer Prevention and Research Institute (ISPO), Florence, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Mantellini
authors.affiliation: Assessorato alle politiche per la salute, Regione Emilia-Romagna, Bologna, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Naldoni
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: Romano
authors.initials: R
authors.lastname: Sassatelli
authors.affiliation: Indiana University School of Medicine, Indiana University Hospital, Indianapolis, Indiana, USA.
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Rex
authors.affiliation: SS Valutazione Screening, Cancer Prevention and Research Institute (ISPO), Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zappa
authors.affiliation: Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000453:epidemiology; D003111:Colonic Polyps / Q000175:diagnosis* / Q000453:epidemiology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009780:Occult Blood; D011127:Polyps / Q000175:diagnosis* / Q000453:epidemiology; D011230:Precancerous Conditions / Q000175:diagnosis / Q000453:epidemiology; D012002:Rectal Diseases / Q000175:diagnosis* / Q000453:epidemiology; D012737:Sex Factors
keywords: COLORECTAL CANCER SCREENING; ENDOSCOPY