Failure of colonoscopy to detect colorectal cancer: evaluation of 47 cases in 20 hospitals☆,☆☆,★,★★
Section snippets
Methods
The study was approved by the Institutional Review Board at Indiana University/Purdue University at Indianapolis, and subsequently by the Institutional Review Boards or ad hoc tumor research committees at all participating hospitals.
Invited hospitals were selected for geographic distribution across central Indiana and for varying hospital size and community size. Data were ultimately collected from a total of 20 hospitals that agreed to participate.
Chart reviews were conducted by
Results
There were 941 colorectal cancer cases in which colonoscopy was used as a primary diagnostic modality. Failure to detect the cancer occurred in 47 cases, for a sensitivity of 95%.
The mean age of the 47 patients was 72 years, compared to 69.8 years for the entire study group. Only 1 patient with a failed detection was under 50 years of age, and 3 were in their sixth decade.
The indications for colonoscopy in cases diagnosed by primary colonoscopy and in cases of failed primary colonoscopy
Discussion
In this report we describe 47 cases of colorectal cancer that were not detected by a colonoscopy performed within 3 years of the date the diagnosis was made. To our knowledge this is the largest reported series of this type. Our findings confirm that while colonoscopy is the gold standard for diagnosis of colonic neoplasia, it is not a perfect test.
We arbitrarily chose a 3-year interval prior to diagnosis to search for procedures that missed the diagnosis of colorectal cancer. This interval
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Cited by (0)
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From the Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana.
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Supported by an Endoscopic Research Award from the American Society for Gastrointestinal Endoscopy.
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Reprint requests: Douglas K. Rex, MD, Indiana University Hospital, Room 2300, 550 University Blvd., Indianapolis, IN 46032.
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