Development and validation of a prediction model for adenoma detection during screening and surveillance colonoscopy with comparison to actual adenoma detection rates.

ABSTRACT

OBJECTIVE: The adenoma detection rate (ADR) varies widely between physicians, possibly due to patient population differences, hampering direct ADR comparison. We developed and validated a prediction model for adenoma detection in an effort to determine if physicians' ADRs should be adjusted for patient-related factors. MATERIALS AND METHODS: Screening and surveillance colonoscopy data from the cross-sectional multicenter cluster-randomized Endoscopic Quality Improvement Program-3 (EQUIP-3) study (NCT02325635) was used. The dataset was split into two cohorts based on center. A prediction model for detection of ≥1 adenoma was developed using multivariable logistic regression and subsequently internally (bootstrap resampling) and geographically validated. We compared predicted to observed ADRs. RESULTS: The derivation (5 centers, 35 physicians, overall-ADR 36%) and validation (4 centers, 31 physicians, overall-ADR 40%) cohort included respectively 9934 and 10034 patients (both cohorts 48% male, median age 60 years). Independent predictors for detection of ≥1 adenoma were age (optimism-corrected odds ratio (OR) 1.02; 95%-confidence interval (CI) 1.02-1.03), male sex (OR 1.73; 95%-CI 1.60-1.88), body mass index (OR 1.02; 95%-CI 1.01-1.03), American Society of Anesthesiology physical status class (OR class II vs. I 1.29; 95%-CI 1.17-1.43, OR class ≥III vs. I 1.57; 95%-CI 1.32-1.86), surveillance versus screening (OR 1.39; 95%-CI 1.27-1.53), and Hispanic or Latino ethnicity (OR 1.13; 95%-CI 1.00-1.27). The model's discriminative ability was modest (C-statistic in the derivation 0.63 and validation cohort 0.60). The observed ADR was considerably lower than predicted for 12/66 (18.2%) physicians and 2/9 (22.2%) centers, and considerably higher than predicted for 18/66 (27.3%) physicians and 4/9 (44.4%) centers. CONCLUSION: The substantial variation in ADRs could only partially be explained by patient-related factors. These data suggest that ADR variation could likely also be due to other factors, e.g. physician or technical issues.