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. 2023 Dec 9;15(3):198-202.
doi: 10.1136/flgastro-2023-102555. eCollection 2024 May.

Colonoscopic cancer detection rate: a new performance measure - is it FIT for purpose?

Khalid Bashir  1 , Iosif Beintaris  2 , Linda Sharp  3 , Julia Newton  4 , Katherine Elliott  5 , Jon Rees  6 , Peter Rogers  7 , Matt Rutter  2
Affiliations

Colonoscopic cancer detection rate: a new performance measure - is it FIT for purpose?

Khalid Bashir et al. Frontline Gastroenterol. .

Abstract

Introduction: Gastrointestinal symptoms correlate poorly with cancer diagnosis. A faecal immunochemical test (FIT) result of ≥10 µg has high sensitivity and negative predictive value for colorectal cancer (CRC) detection. An FIT-based diagnostic pathway may lead to more effective resource utilisation. We aimed to use National Endoscopy Database (NED) data to create a new colonoscopy performance measure, cancer detection rate (CDR) to assess the appropriate identification of target populations for colonoscopy; then to use CDR to assess the impact of implementing an FIT-based referral pathway locally.

Methods: NED data were analysed to compare local diagnostic colonoscopic CDR in 2019 (prepathway revision) and 2021 (postpathway revision), benchmarked against overall national CDR for the same time frames.

Results: 1, 123, 624 NED diagnostic colonoscopies were analysed. Locally, there was a significant increase in CDR between 2019 and 2021, from 3.01% (2.45%-3.47%) to 4.32% (3.69%-4.95%), p=0.003. The CDR increase was due to both a 10% increase in the number of CRCs detected and a 25% reduction in the number of diagnostic colonoscopies performed. Nationally, there was a smaller, but significant, increase in CDR from 2.02% (1.99%-2.07%) to 2.33% (2.29%-2.37%), p<0.001. The rate of increase in CDR% between 2019 and 2021 was significantly different locally compared with nationally.

Conclusion: Our study indicates that the introduction of a robustly vetted FIT-based algorithm to determine whether diagnostic colonoscopy is required, is effective in increasing the colonoscopic CDR. Moreover, CDR appears to be a meaningful performance metric that can be automatically calculated through NED, enabling monitoring of the quality of referral and vetting pathways.

Keywords: colorectal cancer.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Simplified lower gastrointestinal (GI) investigation subalgorithm of the NCA combined GI referral pathway. CTC, computed tomography colonoscopy scan. CT CAP, computed tomography scan of the chest, abdomen and pelvis; NCA, Northern Cancer Alliance.
Figure 2
Figure 2
Mean yearly local and national (excluding local) CDR% (95% CI) for 2019 and 2021. CDR, cancer detection rate.
See this image and copyright information in PMC

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