Endoscopy 2003; 35(6): 506-510
DOI: 10.1055/s-2003-39665
Original Article

© Georg Thieme Verlag Stuttgart · New York

Invasive Colorectal Cancer Detected up to 3 Years after a Colonoscopy Negative for Cancer

O.  Hosokawa 1 , S.  Shirasaki 2 , Y.  Kaizaki 3 , H.  Hayashi 1 , K.  Douden 1 , M.  Hattori 1
  • 1 Dept. of Surgery, Fukui Prefectural Hospital, Fukui, Japan
  • 2 Dept. of Surgery, Tannan Hospital, Sabae, Japan
  • 3 Dept. of Pathology, Fukui Prefectural Hospital, Fukui, Japan
Further Information

Publication History

Submitted 18 April 2002

Accepted after Revision 16 January 2003

Publication Date:
03 June 2003 (online)

Background and Study Aims: Colonoscopy has replaced barium enema as the primary method for direct diagnosis of colorectal cancer, but detection may fail, and the reasons for this are not completely understood.
Patients and Methods: In order to analyze the accuracy of colonoscopy for detecting invasive colorectal cancer, 7365 colonoscopic examinations were matched with the most accurate local government population-based cancer registry in Japan.
Results: In 15 colonoscopic examinations, patients were not diagnosed as having invasive colorectal cancer, but disease of this type was detected within 3 years of the examinations (false-negative examinations). During the same period, 233 colonoscopies were identified as true-positive examinations. The false-negative rate for detecting invasive colorectal cancer with colonoscopy was 6 % at 3 years. The false-negative rate was significantly higher in individuals between 60 and 69 years of age and in invasive cancers located to the right of the splenic flexure.
Conclusions: Colonoscopists should receive adequate training in achieving easy cecal intubation, detecting small or flat lesions, and carrying out adequate biopsies.

References

  • 1 Ferrucci J T. Colonoscopy and barium enema: radiologist's response.  Gastroenterology. 1997;  112 294-296
  • 2 Byrd R L, Boggs H W, Slagle G W, Cole P A. Reliability of colonoscopy.  Dis Colon Rectum. 1989;  32 1023-1025
  • 3 Bensen S, Mott L A, Dain B. et al . The colonoscopic miss rate and true one-year recurrence of colorectal neoplastic polyp.  Am J Gastroenterol. 1999;  94 194-199
  • 4 Rex D K, Cutler C S, Lemmel G T. et al . Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies.  Gastroenterology. 1997;  112 24-28
  • 5 Winawer S J. Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale.  Gastroenterology. 1997;  112 594-642
  • 6 Rex D K, Rahmani E Y, Haseman J H. et al . Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice.  Gastroenterology. 1997;  112 17-23
  • 7 Douden K, Shirasaki S, Takeda T. et al . Evaluation of the overlooked rate of colonoscopy in the ascending colon using the retroflexion colonoscopic examination.  Gastroenterol Endosc. 1999;  41 2044-2050
  • 8 Fukui Cancer Registry, Fukui Prefectural, Government, Fukui Medical Association .Eleventh report [in Japanese]. 1999: 2
  • 9 Schlemper R J, Itabashi M, Kato Y. et al . Differences in the diagnostic criteria used by Japanese and Western pathologists to diagnose colorectal carcinoma.  Cancer. 1998;  82 60-69
  • 10 Winawer S J, Stewart E T, Zauber A G. et al . A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy.  N Engl J Med. 2000;  342 1766-1772
  • 11 Ikeda D M, Andersson I, Wattsgard C. et al . Interval carcinomas in the Malmö mammographic screening trial: radiographic appearance and prognostic considerations.  AJR Am J Roentgenol. 1992;  159 287-294
  • 12 Burhenne H J, Burhenne L W, Goldberg F. et al . Interval breast cancer in screening mammography program of British Columbia: analysis and classification.  AJR Am J Roentgenol. 1994;  162 1067-1071
  • 13 Hosokawa O, Tsuda S, Kidani E. et al . Diagnosis of gastric cancer up to three years after negative upper gastrointestinal endoscopy.  Endoscopy. 1998;  30 669-674
  • 14 Strom E, Larsen J L. Colon cancer at barium enema examination and colonoscopy: a study from the county of Hordaland, Norway.  Radiology. 1999;  211 211-214
  • 15 Haseman J H, Lemmel G T, Rahmani E Y, Rex D K. Failure of colonoscopy to detect colorectal cancer: evaluation of 47 cases in 20 hospitals.  Gastrointest Endosc. 1997;  45 451-455
  • 16 Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer.  Endoscopy. 1993;  25 455-461
  • 17 Rembachen B J, Fujii T, Caims A. et al . Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK.  Lancet. 2000;  355 1211-1214

O. Hosokawa, M.D.

Dept. of Surgery · Fukui Prefectural Hospital

Yotsui 2-8-1, Fukui City · Fukui 910-8526 · Japan

Fax: + 81-776-54-6090

Email: hoso-o@mx2.fctv.ne.jp

    >