Population-based analysis of practices and costs of surveillance for colonic dysplasia in patients with primary sclerosing cholangitis and colitis
Bibliographic record
Abstract
BACKGROUND: Patients with primary sclerosing cholangitis (PSC) and colitis are at risk of developing dysplasia and colorectal cancer (CRC). Consequently, annual surveillance colonoscopy with random biopsies is recommended. The aims of the present study were (1) to determine the incidence of dysplasia or CRC, (2) to assess surveillance practices, and (3) to assess the costs associated with surveillance of PSC patients. METHODS: A population-based study was conducted between 2000 and 2004 to identify all patients with a diagnosis of PSC using regional databases. Colonic histopathology reports of PSC patients with colitis were reviewed to determine the frequency of surveillance colonoscopies performed between 2000 and 2005, the number of biopsies retrieved, and the presence of CRC or dysplasia. The cost of annual surveillance colonoscopy with 33 random biopsies to detect 1 additional case of dysplasia was calculated from a local costs database. RESULTS: Forty-five PSC patients with ulcerative colitis or Crohn's disease were identified. Five patients (11.1%) were diagnosed with low-grade dysplasia (n = 2), dysplasia-associated lesion or mass (n = 2), or CRC (n = 1) during the 5-year follow-up period for an incidence rate of 3.1 events per 100 person-years (95% confidence interval: 1.0-7.2/100 person-years). Two of these lesions were detected through surveillance and 3 because of symptomatic presentation. Only 36% (56) of the expected number of surveillance colonoscopies were performed. The median number of biopsies collected was 27 (IQR: 19-33). The cost of surveillance to detect 1 additional case of dysplasia was USD 26,495. CONCLUSION: Despite a high rate of colorectal dysplasia or CRC among PSC patients, surveillance was suboptimal.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".