Browsing by Subject "detection"

Now showing 1 - 4 of 4
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    Endoscopist Adenoma Per Colonoscopy Detection Rates and Risk for Post Colonoscopy Colorectal Cancer: Data From New Hampshire Colonoscopy Registry
    (Elsevier, 2023-11-21) Anderson, Joseph C.; Rex, Douglas K.; Mackenzie, Todd A.; Hisey, William; Robinson, Christina M.; Butterly, Lynn F.; Medicine, School of Medicine
    Background and Aims Adenomas per colonoscopy (APC) may be a better measure of colonoscopy quality than adenoma detection rate (ADR) since it credits endoscopists for each detected adenoma. There are few data examining the association between APC and post colonoscopy colorectal cancer (PCCRC) incidence. We used data from the New Hampshire Colonoscopy Registry (NHCR) to examine APC and PCCRC risk. Methods We included NHCR patients with an index exam and at least one follow up event, either a colonoscopy or a CRC diagnosis. Our outcome was PCCRC defined as any CRC diagnosed > 6 months after an index exam. The exposure variable was endoscopist specific APC quintiles of 0.25, 0.40, 50 and 0.70. Cox regression was used to model the hazard of PCCRC on APC, controlling for age, sex, year of index exam, index findings, bowel preparation and having more than 1 surveillance exam. Results In 32,535 patients, a lower hazard for PCCRC (n=178) was observed for higher APCs as compared to APCs <0.25 (Reference) (0.25-<0.40:HR=0.35, 95% CI: 0.22-0.56;0.40-<0.50: HR=0.31, 95% CI: 0.20-0.49; 0.50-<0.70: HR=0.20, 95% CI: 0.11-0.36; and ≥0.70: HR=0.19, 95% CI: 0.09-0.37). When examining endoscopists with an ADR of at least 25%, an APC < 0.50 was associated with a significantly higher hazard than an APC > 0.50 (HR=1.65; 95% CI: 1.06-2.56). A large proportion of endoscopists, 1/5th (32/152; 21.1%), had an ADR >25 but an APC <0.50. Discussion Our novel data demonstrating lower PCCRC risk in exams performed by endoscopists with higher APCs suggest that APC could be a useful quality measure. Quality improvement programs may identify important deficiencies in endoscopist detection performance by measuring APC for endoscopists with ADR > 25%.
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    Lead-Time Trajectory of CA19-9 as an Anchor Marker for Pancreatic Cancer Early Detection
    (Elsevier, 2021) Fahrmann, Johannes F.; Schmidt, C. Max; Mao, Xiangying; Irajizad, Ehsan; Loftus, Maureen; Zhang, Jinming; Patel, Nikul; Vykoukal, Jody; Dennison, Jennifer B.; Long, James P.; Do, Kim-Anh; Zhang, Jianjun; Chabot, John A.; Kluger, Michael D.; Kastrinos, Fay; Brais, Lauren; Babic, Ana; Jajoo, Kunal; Lee, Linda S.; Clancy, Thomas E.; Ng, Kimmie; Bullock, Andrea; Genkinger, Jeanine; Yip-Schneider, Michele T.; Maitra, Anirban; Wolpin, Brian M.; Hanash, Samir; Surgery, School of Medicine
    Background & Aims There is substantial interest in liquid biopsy approaches for cancer early detection among subjects at risk, using multi-marker panels. CA19-9 is an established circulating biomarker for pancreatic cancer; however, its relevance for pancreatic cancer early detection or for monitoring subjects at risk has not been established. Methods CA19-9 levels were assessed in blinded sera from 175 subjects collected up to 5 years before diagnosis of pancreatic cancer and from 875 matched controls from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. For comparison of performance, CA19-9 was assayed in blinded independent sets of samples collected at diagnosis from 129 subjects with resectable pancreatic cancer and 275 controls (100 healthy subjects; 50 with chronic pancreatitis; and 125 with noncancerous pancreatic cysts). The complementary value of 2 additional protein markers, TIMP1 and LRG1, was determined. Results In the PLCO cohort, levels of CA19-9 increased exponentially starting at 2 years before diagnosis with sensitivities reaching 60% at 99% specificity within 0 to 6 months before diagnosis for all cases and 50% at 99% specificity for cases diagnosed with early-stage disease. Performance was comparable for distinguishing newly diagnosed cases with resectable pancreatic cancer from healthy controls (64% sensitivity at 99% specificity). Comparison of resectable pancreatic cancer cases to subjects with chronic pancreatitis yielded 46% sensitivity at 99% specificity and for subjects with noncancerous cysts, 30% sensitivity at 99% specificity. For prediagnostic cases below cutoff value for CA19-9, the combination with LRG1 and TIMP1 yielded an increment of 13.2% in sensitivity at 99% specificity ( P = .031) in identifying cases diagnosed within 1 year of blood collection. Conclusion CA19-9 can serve as an anchor marker for pancreatic cancer early detection applications.
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    Right-Sided Location Not Associated With Missed Colorectal Adenomas in an Individual-Level Reanalysis of Tandem Colonoscopy Studies
    (Elsevier, 2019) Zimmermann-Fraedrich, Katharina; Sehner, Susanne; Rex, Douglas K.; Kaltenbach, Tonya; Soetniko, Roy; Wallace, Michael; Leung, Wai K.; Guo, Chuanguo; Gralnek, Ian M.; Brand, Eelco C.; Groth, Stefan; Schachschal, Guido; Ikematsu, Hiroaki; Siersema, Peter D.; Rösch, Thomas; Medicine, School of Medicine
    Background & Aims Interval cancers occur more frequently in the right colon. One reason could be that right-sided adenomas are frequently missed in colonoscopy examinations. We reanalyzed data from tandem colonoscopies to assess adenoma miss rates in relation to location and other factors. Methods We pooled data from 8 randomized tandem trials comprising 2218 patients who had diagnostic or screening colonoscopies (adenomas detected in 49.8% of patients). We performed a mixed-effects logistic regression with patients as cluster effects with different independent parameters. Factors analyzed included location (left vs right, splenic flexure as cutoff), adenoma size, form, and histologic features. Analyses were controlled for potential confounding factors such as patient sex and age, colonoscopy indication, and bowel cleanliness. Results Right-side location was not an independent risk factor for missed adenomas (odds ratio [OR] compared with the left side, 0.94; 95% CI, 0.75–1.17). However, compared with adenomas ≤5 mm, the OR for missing adenomas of 6–9 mm was 0.62 (95% CI, 0.44–0.87), and the OR for missing adenomas of ≥10 mm was 0.51 (95% CI, 0.33–0.77). Compared with pedunculated adenomas, sessile (OR, 1.82; 95% CI, 1.16–2.85) and flat adenomas (OR, 2.47; 95% CI, 1.49–4.10) were more likely to be missed. Histologic features were not significant risk factors for missed adenomas (OR for adenomas with high-grade intraepithelial neoplasia, 0.68; 95% CI, 0.34–1.37 and OR for sessile serrated adenomas, 0.87; 95% CI, 0.47–1.64 compared with low-grade adenomas). Men had a higher number of adenomas per colonoscopy (1.27; 95% CI, 1.21–1.33) than women (0.86; 95% CI, 0.80–0.93). Men were less likely to have missed adenomas than women (OR for missed adenomas in men, 0.73; 95% CI, 0.57–0.94). Conclusions In an analysis of data from 8 randomized trials, we found that right-side location of an adenoma does not increase its odds for being missed during colonoscopy but that adenoma size and histologic features do increase risk. Further studies are needed to determine why adenomas are more frequently missed during colonoscopies in women than men.
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    Secondary caries: what is it, and how it can be controlled, detected, and managed?
    (Springer, 2020-05) Askar, Haitham; Krois, Joachim; Göstemeyer, Gerd; Bottenberg, Peter; Zero, Domenick; Banerjee, Avijit; Schwendicke, Falk; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
    Objectives To assess how to control, detect, and treat secondary caries. This review serves to inform a joint ORCA/EFCD consensus process. Methods Systematic and non-systematic reviews were performed or consulted and narratively synthesized. Results Secondary (or recurrent) caries is defined as a lesion associated with restorations or sealants. While the restorative material itself has some influence on secondary caries, further factors like the presence and size of restoration gaps, patients’ caries risk, and the placing dentist’s experience seem more relevant. Current detection methods for secondary caries are only sparsely validated and likely prone for the risk of over-detection. In many patients, it might be prudent to prioritize specific detection methods to avoid invasive overtreatment. Detected secondary caries can be managed either by repair of the defective part of the restoration or its complete replacement. Conclusions There is sparse data towards the nature of secondary caries and how to control, detect, and treat it.