Comparison of Quality Measures for Detection of Neoplasia at Screening Colonoscopy

The New Kids on the Block: Emerging Complementary Colonoscopy Quality Metrics

“…The study suggests there is little to no added value in measuring AADR, which was inferior to ADR in predicting the risk of PCCRC. 12 Although the predictive powers of PDR, APC, and APPC were similar to ADR, the authors astutely note that PDR would be even more prone to colonoscopist manipulation than ADR. Thus, PDR is unlikely to have a role within most colonoscopy quality programs, with the exception being in resourceconstrained settings where pathology services and reports may not be readily available.…”

“…This study by Wieszczy et al 12 is particularly valuable in the context of rising interest in APC and APPC as more holistic colonoscopy quality metrics that mitigate the "one and done" criticism of ADR. APC and APPC should theoretically be superior to ADR in assessing how well a colonoscopist examines the entire colon and has shown promise in prior literature.…”

“…In this issue of Clinical Gastroenterology and Hepatology, Wieszczy et al 12 start closing this knowledge gap by investigating the relationship between multiple quality metrics (ADR, APC, adenomas per positive colonoscopy [APPC], polyp detection rate [PDR], advanced adenoma detection rate [AADR]) and the risk of PCCRC and related mortality. In this retrospective cohort study of 173,287 screening-eligible adults in the Polish Colonoscopy Screening program followed from 2000 to 2011, all studied metrics were significantly associated with PCCRC risk, with the highest relative risk reduction observed for ADR 24.9% (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.25-0.66 compared with ADR <12.1%), PDR 42.7% (HR, 0.35; 95% CI, 0.24-0.51 compared with PDR <19.9%), and APC 0.37 (HR, 0.35; 95% CI, 0.21-0.58 compared with APC <0.15).…”

“…For institutions equipped with the resources to measure APC and APPC, these will likely be the most worthwhile complementary metrics to pursue because they address potential ADR "gaming". Although the study by Wieszczy et al 12 suggests similar predictive value of APC, APPC, and ADR for PCCRC risk, it remains limited by relatively low rates of adenoma detection, and the body of evidence supporting APC and APPC as superior differentiators of colonoscopy performance cannot be overlooked. 7,12,16 The technical feasibility of measuring APC presents a significant challenge.…”

“…Although the study by Wieszczy et al 12 suggests similar predictive value of APC, APPC, and ADR for PCCRC risk, it remains limited by relatively low rates of adenoma detection, and the body of evidence supporting APC and APPC as superior differentiators of colonoscopy performance cannot be overlooked. 7,12,16 The technical feasibility of measuring APC presents a significant challenge. Implementation of APC monitoring would require discernment of how many adenomas are detected within a given pathology specimen, because the alternative of bottling every polyp separately can be costly and environmentally unfriendly.…”