Proximal serrated polyp detection may add to ADR in PCCRC risk assessment

A secondary analysis of screening colonoscopies in the Swedish SCREESCO trial examined whether proximal serrated polyp detection rate (PSPDR) was associated with postcolonoscopy colorectal cancer (PCCRC). PCCRC incidence was lower among endoscopists with higher PSPDR, including those with high adenoma detection rates, but few cancer events limit certainty.

Higher PSPDR was associated with lower PCCRC incidence.
The association persisted among endoscopists with high ADR.
Only 37 PCCRC events were identified across both screening groups.

Researchers analyzed colonoscopy data from 9,982 participants in the colonoscopy screening arm and 5,875 participants who underwent colonoscopy after fecal immunochemical testing in the SCREESCO trial. PCCRC was defined as colorectal cancer diagnosed more than six months after a colonoscopy that had not detected cancer. Cancer-registry linkage identified PCCRC, and Cox models were used to assess associations with PSPDR and adenoma detection rate (ADR).

PCCRC was identified in 20 participants in the colonoscopy arm and 17 in the FIT arm. Five-year cumulative PCCRC incidence was 0.16% for colonoscopies performed by endoscopists with PSPDR below 10%, compared with 0.06% for those with PSPDR of at least 10%. Among endoscopists with high ADR, incidence was 0.13% with low PSPDR versus 0.06% with high PSPDR. In this group, each percentage-point increase in PSPDR was associated with lower PCCRC incidence over eight years (hazard ratio 0.90; 95% CI 0.82–1.00; P=0.04).

PCCRCs more often involved the right colon and advanced stage than screening-detected cancers. The findings suggest PSPDR may provide information beyond ADR for assessing colonoscopy quality, but the small number of PCCRC events makes the estimates uncertain; the study does not establish a threshold or prove that raising PSPDR reduces cancer risk.

In practice

For clinicians and endoscopy services assessing colonoscopy quality, these findings suggest proximal serrated polyp detection rate may add information to adenoma detection rate when considering PCCRC risk. In the screening cohort, higher PSPDR was associated with lower PCCRC incidence, including among endoscopists with high ADR. However, only 37 PCCRC events were identified, and the analysis is observational; it does not show that increasing PSPDR will reduce cancer incidence or establish a target threshold. The results do not by themselves justify changing practice standards.

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Source

Endoscopy: Serrated polyp detection rates beyond adenoma detection rate for postcolonoscopy colorectal cancer: findings from the SCREESCO trial ↗

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