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Colonoscopic cancer detection rate: a new performance measure – is it FIT for purpose?

Bashir, Khalid, Beintaris, Iosif, Sharp, Linda, Newton, Julia, Elliott, Katharine, Rees, Jon, Rogers, Peter and Rutter, Matt (2023) Colonoscopic cancer detection rate: a new performance measure – is it FIT for purpose? Frontline Gastroenterology. ISSN 2041-4137

Item Type: Article


Introduction: Gastrointestinal symptoms correlate poorly with cancer diagnosis. A Faecal
Immunochemical Test (FIT) result of ≥10μg has high sensitivity and negative predictive value for
colorectal cancer (CRC) detection. A FIT-based diagnostic pathway may lead to more effective
resource utilisation. We aimed to use National Endoscopy Database (NED) data to create a new
colonoscopy performance measure, cancer detection rate (CDR) to assess the appropriate
identification of target populations for colonoscopy; then to use CDR to assess the impact of
implementing a FIT-based referral pathway locally.
Methods: NED data was analysed to compare local diagnostic colonoscopic CDR in 2019 (pre�pathway revision) and 2021 (post-pathway revision), benchmarked against overall national CDR for
the same timeframes.
Results: 1,123,624 NED diagnostic colonoscopies were analysed. Locally, there was a significant
increase in CDR between 2019 and 2021, from 3.01%[2.45–3.47%] to 4.32%[3.69–4.95%],p=0.003.
The CDR increase was due to both a 10% increase in the number of colorectal cancers detected and
a 25% reduction in the number of diagnostic colonoscopies performed. Nationally, there was a
smaller, but significant, increase in CDR from 2.02%[1.99 – 2.07%] to 2.33%[2.29 – 2.37%],p<0.001.
The rate of increase in CDR% between 2019 and 2021 was significantly different locally compared to
Conclusion: Our study indicates that the introduction of a robustly-vetted FIT-based algorithm to
determine whether diagnostic colonoscopy is required, is effective in increasing the colonoscopic
CDR. Moreover, CDR appears to be a meaningful performance metric that can be automatically
calculated through NED, enabling monitoring of the quality of referral and vetting pathways.

NED FIT NTHFT_rev Nov 2023_main article.pdf - Accepted Version
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More Information

Depositing User: Jon Rees


Item ID: 17126
Identification Number:
ISSN: 2041-4137
Official URL:

Users with ORCIDS

ORCID for Julia Newton: ORCID iD
ORCID for Jon Rees: ORCID iD

Catalogue record

Date Deposited: 21 Dec 2023 08:44
Last Modified: 29 Apr 2024 10:15


Author: Julia Newton ORCID iD
Author: Jon Rees ORCID iD
Author: Khalid Bashir
Author: Iosif Beintaris
Author: Linda Sharp
Author: Katharine Elliott
Author: Peter Rogers
Author: Matt Rutter

University Divisions

Faculty of Health Sciences and Wellbeing > School of Psychology


Sciences > Health Sciences

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