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Detection rate and predictive factors of sessile serrated polyps in an organised colorectal cancer screening programme with immunochemical faecal occult blood test: the EQuIPE study (Evaluating Quality Indicators of the Performance of Endoscopy)
  1. Manuel Zorzi1,
  2. Carlo Senore2,
  3. Filippo Da Re3,
  4. Alessandra Barca4,
  5. Luigina Ada Bonelli5,
  6. Renato Cannizzaro6,
  7. Giovanni de Pretis7,
  8. Lucia Di Furia8,
  9. Emilio Di Giulio9,
  10. Paola Mantellini10,
  11. Carlo Naldoni11,
  12. Romano Sassatelli12,
  13. Douglas K Rex13,
  14. Marco Zappa14,
  15. Cesare Hassan15,
  16. the Equipe Working Group
    1. 1 Veneto Tumour Registry, Regione Veneto, Padova, Italy
    2. 2 CPO Piemonte and San Giovanni Battista University Hospital, Turin, Turin, Italy
    3. 3 Settore promozione e sviluppo igiene e sanità pubblica, Regione Veneto, Venice, Italy
    4. 4 Regione Lazio, Rome, Italy
    5. 5 SS Prevenzione Secondaria e Screening, IRCCS AOU San Martino-IST, Genova, Italy
    6. 6 Department of Oncological Gastroenterology, National Cancer Institute, IRCCS, Centro di Riferimento Oncologico, Aviano, PN, Italy
    7. 7 U.O. multizonale di Gastroenterologia, Ospedale S. Chiara, Trento, Italy
    8. 8 Agenzia Regionale Sanitaria, Regione Marche, Ancona, Italy
    9. 9 Endoscopia Digestiva, Università di Roma ‘Sapienza’, Azienda Ospedaliera Sant'Andrea, Rome, Italy
    10. 10 Clinical Epidemiology, Cancer Prevention and Research Institute (ISPO), Florence, Italy
    11. 11 Assessorato alle politiche per la salute, Regione Emilia-Romagna, Bologna, Italy
    12. 12 Unit of Gastroenterology and Digestive Endoscopy, Arcispedale Santa Maria Nuova—IRCCS, Reggio Emilia, Italy
    13. 13 Indiana University School of Medicine, Indiana University Hospital, Indianapolis, Indiana, USA
    14. 14 SS Valutazione Screening, Cancer Prevention and Research Institute (ISPO), Florence, Italy
    15. 15 Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
    1. Correspondence to Dr Manuel Zorzi, Veneto Tumour Registry, Passaggio Gaudenzio, 1, Padova 35131, Italy; manuel.zorzi{at}


    Objectives To assess detection rate and predictive factors of sessile serrated polyps (SSPs) in organised colorectal cancer (CRC) screening programmes based on the faecal immunochemical test (FIT).

    Design Data from a case series of colonoscopies of FIT-positive subjects were provided by 44 Italian CRC screening programmes. Data on screening history, endoscopic procedure and histology results, and additional information on the endoscopy centre and the endoscopists were collected, including the age-standardised and sex-standardised adenoma detection rate (ADR) of the individual endoscopists. The SSP detection rate (SSP-DR) was assessed for the study population. To identify SSP-predictive factors, multilevel analyses were performed according to patient/centre/endoscopist characteristics.

    Results We analysed 72 021 colonoscopies, of which 1295 presented with at least one SSP (SSP-DR 1.8%; 95% CI 1.7% to 1.9%). At the per-patient level, SSP-DR was associated with males (OR 1.35; 95% CI 1.17 to 1.54) and caecal intubation (OR 3.75; 95% CI 2.22 to 6.34), but not with the FIT round. The presence of at least one advanced adenoma was more frequent among subjects with SSPs than those without (OR 2.08; 95% CI 1.86 to 2.33). At the per-endoscopist level, SSP-DR was associated with ADR (third vs first ADR quartile: OR 1.55; 95% CI 1.03 to 2.35; fourth vs first quartile: OR 1.89; 95% CI 1.24 to 2.90).

    Conclusion The low prevalence of SSPs and the lack of association with the FIT round argue against SSP as a suitable target for FIT-based organised programmes. Strict association of SSP-DR with the key colonoscopy quality indicators, namely caecal intubation rate and high ADR further marginalises the need for SSP-specific quality indicators in FIT-based programmes.


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