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ARTICLE

Location of Adenomas Missed by Optical Colonoscopy

Perry J. Pickhardt, MD; Pamela A. Nugent, MD; Pauline A. Mysliwiec, MD, MPH; J. Richard Choi, ScD, MD; and William R. Schindler, DO

7 September 2004 | Volume 141 Issue 5 | Pages 352-359

Background: Previous estimates of the adenoma miss rate with optical colonoscopy (OC) are hindered by the use of OC as its own reference standard.

Objective: To evaluate the frequency and characteristics of colorectal neoplasms that are missed prospectively on OC by using virtual colonoscopy (VC) as a separate reference standard.

Design: Prospective, multicenter screening trial.

Setting: 3 medical centers.

Participants: 1233 asymptomatic adults who underwent same-day VC and OC.

Measurements: Colorectal neoplasms (adenomatous polyps) missed at OC before VC results were unblinded.

Results: Fourteen (93.3%) of 15 nonrectal neoplasms were located on a fold; 10 (71.4%) of these were located on the backside of a fold. Five (83.3%) of 6 rectal lesions were located within 10 cm of the anal verge.

Limitations: Estimation of the OC miss rate depended on polyp detection on both VC and second-look OC and therefore underestimates the true OC miss rate, particularly for smaller polyps.

Conclusions: Most clinically significant adenomas missed prospectively on OC are located behind a fold or near the anal verge. The 12% OC miss rate for large adenomas ( 10 mm) when state-of-the-art 3-dimensional VC is used as a separate reference standard is increased from the previous 0% to 6% estimates derived by using OC as its own reference standard.

Editors' Notes Context How often does colonoscopy miss adenomas? Contribution During a multicenter screening trial, experienced colonoscopists performed same-day optical (OC) and virtual colonoscopy (VC) on 1233 asymptomatic adults. Optical colonoscopy performed without knowledge of the VC findings missed 55 of 511 polyps; 21 of these polyps were adenomas measuring 6 mm or greater. Adenomas missed by OC were usually on the proximal side of a fold or near the anal verge. Virtual colonoscopy missed 14% of the adenomas that measured 6 mm or greater that were de-tected by OC. Implications Neither OC nor VC is a perfect test: Each misses 10% to 14% of adenomas that measure 6 mm or greater. –The Editors

 

Author and Article Information

From the University of Wisconsin Medical School, Madison, Wisconsin; National Naval Medical Center, Uniformed Services University of the Health Sciences, and National Cancer Institute, Bethesda, Maryland; Walter Reed Army Medical Center, Washington, DC; and Naval Medical Center San Diego, San Diego, California.

Disclaimer: The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Navy, U.S. Army, or U.S. Department of Defense.

Acknowledgment: The authors thank Cara Olsen, Biostatistics Consulting Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, for her statistical analysis support.

Grant Support: By the U.S. Department of Defense Advances in Medical Practice (AMP) funds.

Potential Financial Conflicts of Interest:Patents pending: P.J. Pickhardt (Naval Medical Research Center).

Requests for Single Reprints: Perry J. Pickhardt, MD, Department of Radiology, University of Wisconsin Medical School, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3252; e-mail, ppickhardt{at}mail.radiology.wisc.edu.

Current Author Addresses: Dr. Pickhardt: Department of Radiology, University of Wisconsin Medical School, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3252.

Dr. Nugent: Department of Radiology, National Naval Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889-5600.

Dr. Mysliwiec: Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California, Davis, Medical Center, 4150 V Street, Suite 3500, Sacramento, CA 95817.

Dr. Choi: Department of Radiology, Walter Reed Army Medical Center, 6900 Georgia Ave NW, Washington, DC 20307.

Dr. Schindler: Department of Gastroenterology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134.

Author Contributions: Conception and design: P.J. Pickhardt, P.A. Mysliwiec, J.R. Choi, W.R. Schindler.

Analysis and interpretation of the data: P.J. Pickhardt, P.A. Mysliwiec, J.R. Choi, W.R. Schindler.

Drafting of the article: P.J. Pickhardt, P.A. Mysliwiec, J.R. Choi.

Critical revision of the article for important intellectual content: P.J. Pickhardt, P.A. Mysliwiec.

Final approval of the article: P.J. Pickhardt, P.A. Nugent, P.A. Mysliwiec, J.R. Choi, W.R. Schindler.

Provision of study materials or patients: P.J. Pickhardt, P.A. Nugent, J.R. Choi, W.R. Schindler.

Obtaining of funding: P.J. Pickhardt, J.R. Choi.

Administrative, technical, or logistic support: P.J. Pickhardt, P.A. Nugent, J.R. Choi, W.R. Schindler.

Collection and assembly of data: P.J. Pickhardt, P.A. Nugent, P.A. Mysliwiec, J.R. Choi, W.R. Schindler.

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