Risk of Advanced Proximal Neoplasms According to Distal Colorectal Findings: Comparison of Sigmoidoscopy-Based Strategies

Abstract

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.

Prediction of proximal advanced neoplasia: a comparison of four existing sigmoidoscopy-based strategies in a Chinese population

“…The sensitivity and specificity of these strategies were compared by pair-wise McNemar test for paired proportions. Similar to Castells et al ,20 the performance characteristics of these criteria in detecting APN were evaluated overall, and by different age (50–59 years and 60–69 years) and gender strata (male vs female).…”

“…Only four existing sets of criteria are available and they are conducted in three European nations16–18 and the USA 19. Recently, the accuracy and resources needed to detect one APN16–18 based on the characteristics of distal lesions alone have been compared using the three European criteria,20 but the validation cohort was recruited from Spanish cities 21. In Asian countries, especially in resource-deprived regions, manpower for colonoscopy is limited and should be used in a cost-effective manner.…”

“…We adopted the method used by Castells et al 20 who compared the performance of the different criteria in an independent dataset. We assessed the three European criteria based on distal lesions16–18 and the criteria from the USA based on age, gender and distal lesions19 for prediction of APN.…”

Effectiveness, training and quality assurance of colonoscopy screening for colorectal cancer

“…Castells and coworkers recently compared flexible sigmoidoscopy with colonoscopy screening, applying data from the four randomised sigmoidoscopy trials with yield data from the ongoing COLONPREV colonoscopy trial 18. Depending on the threshold for referral, flexible sigmoidoscopy detected between 57% and 65% of individuals with advanced proximal adenomas.…”

Findings in the Distal Colorectum Are Not Associated With Proximal Advanced Serrated Lesions

“…Sigmoidoscopy effectively decreases distal CRC incidence and mortality; however, its effect on right-sided CRC depends on the colonoscopy referral strategy in place. The 4 large randomized trials of screening sigmoidoscopy [5][6][7]10 have employed different criteria to refer patients to colonoscopy, but all are based on the premise that the risk of advanced neoplasia in the proximal colon can be predicted according to findings in the distal colon, allowing the adjudication of colonoscopy referrals based on the presence and characteristics of polyps found at sigmoidoscopy 11 . In this context, the term "advanced neoplasia" has been used to refer mainly to lesions on the spectrum of the adenoma-carcinoma sequence, including invasive cancer and advanced adenomas (size ≥ 10 mm or presence of high-grade dysplasia or significant villous components on histology).…”