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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(11): E1366-E1373
DOI: 10.1055/a-2417-6248
Original article

Which is the better polyp detection metric: adenomas per colonoscopy or adenoma detection rate? A simulation modeling study

Todd MacKenzie
1   Department of Biomedical Data Science, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, United States (Ringgold ID: RIN539576)
2   Department of Medicine, Dartmouth College Geisel School of Medicine, Hanover, United States (Ringgold ID: RIN12285)
,
Sikai Xiao
3   The Analytics Institute, Dartmouth-Hitchcock Medical Center, Lebanon, United States (Ringgold ID: RIN22916)
,
William H Hisey
4   Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, United States (Ringgold ID: RIN22916)
5   New Hampshire Colonoscopy Registry, Lebanon, United States
,
Christina M Robinson
4   Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, United States (Ringgold ID: RIN22916)
5   New Hampshire Colonoscopy Registry, Lebanon, United States
,
Lynn Butterly
4   Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, United States (Ringgold ID: RIN22916)
,
Joseph C Anderson
6   Dartmouth College Geisel School of Medicine, Hanover, United States (Ringgold ID: RIN12285)
7   White River Junction VA Medical Center, White River Junction, United States (Ringgold ID: RIN20127)
8   University of Connecticut School of Medicine, Farmington, United States (Ringgold ID: RIN12227)
› Author AffiliationsOptimizing colorectal cancer prevention: a multi-disciplinary, population-based investigation of serrated polyps using risk prediction and modeling; Grant Recipient: Lynn F. Butterly, M.D.
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Abstract

Background and study aims We compared the ability of adenoma detection rate (ADR) and adenoma per colonoscopy (APC) to assess endoscopist detection, using statistical principles and simulations.

Patients and methods We simulated a population of endoscopists and patients to compare the ability of ADR versus APC for capturing true endoscopist ability (TEA). We compared these rates with and without adjustment for patient and exam factors using multivariable models, and adjustment for imprecision due to low volume using empirical Bayes (shrinkage). Power calculations were used to compare the ability of ADR and APC to distinguish higher from lower rates over two time periods for an endoscopist.

Results APC and ADR had similar discriminatory ability for assessing TEA. This increased with higher volumes and after adjusting for risk factors and low volume using shrinkage. Higher APC and ADRs had higher power for comparing endoscopist detection over two time periods, but APC was superior to ADR. For example, there was 29% power to distinguish APCs (n = 200 colonoscopies) 0.10 from 0.15, similar to the power (28%) to distinguish corresponding ADRs: 10% and 14%. However, at same volume (n = 200), the power to distinguish higher APC rates (0.50 vs.0.75) was greater (89%) than the power (78%) for corresponding ADRs (39% vs.53%).

Conclusions Adjusting for patient and exam factors and/or using shrinkage techniques for lower-volume endoscopists can increase the correlation between TEA for both ADR and APC. For higher detection rates, APC offers more power than ADR in distinguishing differences in detection ability.

Keywords

Endoscopy Lower GI Tract - Polyps / adenomas / ... - CRC screening - Statistics

Supplementary Material



Publication History

Received: 16 July 2024

Accepted after revision: 18 September 2024

Accepted Manuscript online:
14 October 2024

Article published online:
28 November 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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