Quality Assessment of Colonoscopy—Colonoscopic Miss Rates for Colon Cancer in the Private Practice Setting
Bibliographic record
Abstract
Purpose: Data from the national polyp study indicates that surveillance colonoscopy with removal of adenomatous polyps reduces the incidence of colorectal cancer. Recent data from Canada indicates that 4% of patients with cancers located in the right colon had colonoscopy within 36 months of their diagnosis suggesting that these lesions may have been missed by colonoscopy. The aim of this study was to identify the rate of missed colon cancers in a large private practice to provide benchmark data for use in colonoscopy quality assessment programs. Methods: Medical records were reviewed from a 13 man single specialty private practice group located in Rockford, IL. All partners are board certified and have all performed a minimum of 2,000 colonoscopies. Cecal intubation rates exceed 98% for all participating colonoscopists. Patients who developed colon cancer between 2003 and 2004 were identified. Colonoscopy records were reviewed and patients who had a previous colonoscopy between 6 and 36 months were considered to have missed lesions. Colonoscopies performed within 6 months of the diagnosis were considered to be the index procedure. Additional data collected included patient demographics, location of cancer, number of previous colonoscopies, and family history of colon cancer. Results: During the period from 2003 to 2004, 16147 colonoscopies were performed. Colon cancer was identified in 206 patients for a rate of 1.3%. Of these 206, 10 (4.9%) had a colonoscopy between 6 and 36 months prior to their diagnosis suggesting that these lesions were missed. The mean age of these patients was 66.3 years with a range of 49 – 82 years; 8 were female and 2 males. 80% of the missed lesions were in the right colon and the other 20% in the rectosigmoid. Four of the six had a family history of colon cancer but none had a first degree relative. Conclusions: The rate of missed colon cancers in a large private practice group is similar to that observed in other studies suggesting that this rate is likely to be accurate. This data can be utilized to provide a starting point for determining benchmark rates to be used in future quality assessment of colonoscopy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.024 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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 source (direct Gemma or distilled Codex), 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".