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Journal of Gastrointestinal Cancer

, Volume 38, Issue 2–4, pp 148–153 | Cite as

Relative Rates of Missed Diagnosis for Colonoscopy, Barium Enema, and Flexible Sigmoidoscopy in 379 Patients with Colorectal Cancer

  • Catherine T. FrenetteEmail author
  • Williamson B. Strum
Article

Abstract

Background

Failures of diagnosis of colorectal cancer by colonoscopy, barium enema, and flexible sigmoidoscopy have been demonstrated using various techniques. A relative assessment of these diagnostic tests for patients with colorectal cancer has not been reported. This study was designed to determine relative rates of failures for these tests when applied to diagnosis of colorectal cancer.

Methods

We created a database of patients with colorectal cancer diagnosed between 2000 and 2005. Records were reviewed for the results of colonoscopy, barium enema, and flexible sigmoidoscopy in the 3 years prior to diagnosis. An examination that was negative for cancer with no immediate follow-up was defined as a failure of diagnosis, either from inaccurate observation, failure to examine the entire colon, or failure of timely follow-up. The failure rates were compared.

Results

Three hundred seventy-nine patients, who had 421 examinations, were analyzed. The diagnosis of colorectal cancer failed in 60 of 379 patients (16%). These 60 patients had 71 examinations that failed to make the diagnosis: 25 of 282 colonoscopies (9%), 16 of 79 barium enemas (20%), and 30 of 60 flexible sigmoidoscopies (50%). These differences were statistically significant.

Conclusions

Failure rates for colonoscopy, barium enema, and flexible sigmoidoscopy were 9%, 20%, and 50%.

Keywords

colon cancer colonoscopy barium enema flexible sigmoidoscopy 

Abbreviations

BE

Barium enema

CRC

colorectal cancer

FOBT

Fecal occult blood test

FS

Flexible sigmoidoscopy

OC

Optical colonoscopy

Notes

Acknowledgements

We gratefully acknowledge Sharon Reid and Clarence Sandbakken of the Scripps Clinic Cancer Registry and Dr. James Koziol and Anne Feng of the Biostatistics Department of The Scripps Research Institute for their invaluable assistance.

References

  1. 1.
    American Cancer Society. Colorectal cancer facts and figures special edition 2008. Atlanta: American Cancer Society; 2008.Google Scholar
  2. 2.
    Winawer S, Fletcher R, Rex D, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale—update based on new evidence. Gastroenterology 2003;124:544–60. doi: 10.1053/gast.2003.50044.PubMedCrossRefGoogle Scholar
  3. 3.
    Ransohoff D. Colon cancer screening in 2005: status and challenges. Gastroenterology 2005;128:1685–95. doi: 10.1053/j.gastro.2005.04.005.PubMedCrossRefGoogle Scholar
  4. 4.
    Bressler B, Paszat L, Vinden C, et al. Colonoscopic miss rates for right-sided colon cancer: a population-based analysis. Gastroenterology 2004;127:452–6. doi: 10.1053/j.gastro.2004.05.032.PubMedCrossRefGoogle Scholar
  5. 5.
    Rex D, Cutler C, Lemmel G, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology 1997;112:24–8. doi: 10.1016/S0016-5085(97)70214-2.PubMedCrossRefGoogle Scholar
  6. 6.
    Van Rijn J, Reitsma J, Stoker J, et al. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol. 2006;101:343–50. doi: 10.1111/j.1572-0241.2006.00390.x.PubMedCrossRefGoogle Scholar
  7. 7.
    Van Gelder R, Nio CY, Florie J, et al. Computed tomographic colonography compared with colonoscopy in patients at increased risk for colorectal cancer. Gastroenterology 2004;127:41–8. doi: 10.1053/j.gastro.2004.03.055.PubMedCrossRefGoogle Scholar
  8. 8.
    Pickhardt P, Nugent P, Mysliwiec P, et al. Location of adenomas missed by optical colonoscopy. Ann Intern Med. 2004;141:352–9.PubMedGoogle Scholar
  9. 9.
    Kim D, Pickhardt P, Taylor A, et al. CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med. 2007;357:1403–12. doi: 10.1056/NEJMoa070543.PubMedCrossRefGoogle Scholar
  10. 10.
    Pickhardt P, Choi J, Hwang I, et al. Computed tomography virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med. 2003;349:2191–200. doi: 10.1056/NEJMoa031618.PubMedCrossRefGoogle Scholar
  11. 11.
    Rex D, Rahmani E, Haseman J, et al. Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. Gastroenterology 1997;112:117–23.Google Scholar
  12. 12.
    Schrock T. Colonoscopy versus barium enema in the diagnosis of colorectal cancers and polyps. Gastrointest Endosc Clin N Am. 1993;3:585–610.Google Scholar
  13. 13.
    Winawer SJ, Stewart ET, Zauber AG, et al. A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. N Engl J Med. 2000;342:1766–72. doi: 10.1056/NEJM200006153422401.PubMedCrossRefGoogle Scholar
  14. 14.
    Saito Y, Slezak P, Rubio C. The diagnostic value of combining flexible sigmoidoscopy and double-contrast barium enema as a one-stage procedure. Gastrointest Radiol. 1989;14:357–9. doi: 10.1007/BF01889237.PubMedCrossRefGoogle Scholar
  15. 15.
    Lieberman D, Weiss D, Bond J, et al. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Engl J Med. 2000;343:162–8. doi: 10.1056/NEJM200007203430301.PubMedCrossRefGoogle Scholar
  16. 16.
    Imperiale T, Wagner D, Lin C, et al. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med. 2000;343:169–74. doi: 10.1056/NEJM200007203430302.PubMedCrossRefGoogle Scholar
  17. 17.
    Leaper M, Johnston MJ, Barclay M, et al. Reasons for failure to diagnose colorectal carcinoma at colonoscopy. Endoscopy 2004;36:499–503. doi: 10.1055/s-2004-814399.PubMedCrossRefGoogle Scholar
  18. 18.
    Shehadeh I, Rebala S, Kumar R, et al. Retrospective analysis of missed advanced adenomas on surveillance colonoscopy. Am J Gastroenterol. 2002;97:1143–7. doi: 10.1111/j.1572-0241.2002.05680.x.PubMedCrossRefGoogle Scholar
  19. 19.
    Regula J, Rupinski M, Kraszewska E, et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med. 2006;355:1863–72. doi: 10.1056/NEJMoa054967.PubMedCrossRefGoogle Scholar
  20. 20.
    Strum WB. Impact of a family history of colorectal cancer on age at diagnosis, anatomic location, and clinical characteristics of colorectal cancer. Int J Gastrointest Cancer. 2005;35:121–6. doi: 10.1385/IJGC:35:2:121.PubMedCrossRefGoogle Scholar
  21. 21.
    Strum WB. Impact of a family history of colorectal cancer on the prevalence of advanced adenomas of the rectosigmoid colon at flexible sigmoidoscopy in 3147 asymptomatic patients. Dig Dis Sci. 2006;51:2048–52. doi: 10.1007/s10620-006-9660-9.PubMedCrossRefGoogle Scholar
  22. 22.
    Strum WB. Impact of adenoma size in distal colon on risk for advanced adenoma of the proximal colon. Dig Dis Sci. 2006;51:2064–7. doi: 10.1007/s10620-005-9066-0.PubMedCrossRefGoogle Scholar
  23. 23.
    Chen T, Yen M, Lai M, et al. Evaluation of a selective screening for colorectal carcinoma: the Taiwan Multicenter Cancer Screening (TAMCAS) project. Cancer 1999;86:1116–28. doi: 10.1002/(SICI)1097-0142(19991001)86:7<1116::AID-CNCR4>3.0.CO;2-D.PubMedCrossRefGoogle Scholar
  24. 24.
    Winawer S, Zauber A, Ho M, et al. Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med. 1993;329:1977–81. doi: 10.1056/NEJM199312303292701.PubMedCrossRefGoogle Scholar
  25. 25.
    Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, et al. Screening and surveillance for early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 2008;134:1570–95. doi: 10.1053/j.gastro.2008.02.002.PubMedCrossRefGoogle Scholar
  26. 26.
    Imperiale TF, Ransohoff DF, Itzhowitz SH, et al. Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population. N Engl J Med. 2004;351:2704–14. doi: 10.1056/NEJMoa033403.PubMedCrossRefGoogle Scholar
  27. 27.
    Moravec M, Lieberman D, Holub J, et al. Rate of advanced pathologic features in 6–9 mm polyps in patients referred for colonoscopic screening. Gastrointest Endosc. 2007;65:822. doi: 10.1016/j.gie.2007.03.1064.CrossRefGoogle Scholar
  28. 28.
    Johnson C, Carlson H, Taylor W, et al. Barium enemas of carcinoma of the colon: sensitivity of double- and single-contrast studies. Am J Roentgenol. 1983;140:1143–9.Google Scholar
  29. 29.
    Selby JV, Friedman GD, Quesenberry CP, et al. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med. 1992;326:653–7.PubMedGoogle Scholar
  30. 30.
    Doria-Rose VP, Levin TR, Selby JV, et al. The incidence of colorectal cancer following a negative screening sigmoidoscopy: implications for screening interval. Gastroenterology 2004;127:714–22. doi: 10.1053/j.gastro.2004.06.048.PubMedCrossRefGoogle Scholar
  31. 31.
    Rex DK. Colonoscopic withdrawal technique is associated with adenoma miss rates. Gastrointest Endosc. 2000;51:33–6. doi: 10.1016/S0016-5107(00)70383-X.PubMedCrossRefGoogle Scholar
  32. 32.
    Barclay RL, Vicari JJ, Doughty AS, et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006;355:2533–41. doi: 10.1056/NEJMoa055498.PubMedCrossRefGoogle Scholar
  33. 33.
    Lieberman D. A call to action—measuring the quality of colonoscopy. N Engl J Med. 2006;355:2588–9. doi: 10.1056/NEJMe068254.PubMedCrossRefGoogle Scholar
  34. 34.
    East J, Suzuki N, Arebi N, et al. Position changes improve visibility during colonoscope withdrawal: a randomized, blinded crossover trial. Gastrointest Endosc. 2007;65:263–9. doi: 10.1016/j.gie.2006.04.039.PubMedCrossRefGoogle Scholar
  35. 35.
    East J, Saunders B, Burling D, et al. Surface visualization at CT colonography simulated colonoscopy: effect of varying field of view and retrograde view. Am J Gastroenterol. 2007;102:2529–935. doi: 10.1111/j.1572-0241.2007.01429.x.PubMedCrossRefGoogle Scholar
  36. 36.
    Soetikno R, Kaltenbach T, Rouse R, et al. Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. J Am Med Assoc. 2008;299:1027–35. doi: 10.1001/jama.299.9.1027.CrossRefGoogle Scholar
  37. 37.
    Davila RE, Rajan E, Baron TH, Adler DG, Egan JV, Faigel DO, et al. ASGE guideline: colorectal cancer screening and surveillance. Gastrointest Endosc. 2006;63:546–57. doi: 10.1016/j.gie.2006.02.002.PubMedCrossRefGoogle Scholar
  38. 38.
    Winawer S, Zauber A, Fletcher R, et al. Guidelines for colonoscopic surveillance after polypectomy: a consensus update by the US multi-society task force on colorectal cancer and the American Cancer Society. Gastroenterology 2006;130:1872–85. doi: 10.1053/j.gastro.2006.03.012.PubMedCrossRefGoogle Scholar
  39. 39.
    Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med. 1992;326:658–62.PubMedGoogle Scholar
  40. 40.
    Bressler B, Paszat LF, Chen Z, et al. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology 2007;132:96–102. doi: 10.1053/j.gastro.2006.10.027.PubMedCrossRefGoogle Scholar
  41. 41.
    Shah HA, Paszat LF, Saskin R, et al. Factors associated with incomplete colonoscopy: a population-based study. Gastroenterology 2007;132:2297–303. doi: 10.1053/j.gastro.2007.03.032.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc. 2008

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyScripps Clinic and The Scripps Research InstituteLa JollaUSA
  2. 2.San FranciscoUSA

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