Introduction Gastrointestinal symptoms correlate poorly with cancer diagnosis. A faecal immunochemical test (FIT) result of ≥10 µg has high sensitivity and negative predictive value for colorectal cancer (CRC) detection. An 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 an FIT-based referral pathway locally. Methods NED data were analysed to compare local diagnostic colonoscopic CDR in 2019 (prepathway revision) and 2021 (postpathway revision), benchmarked against overall national CDR for the same time frames. 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 CRCs 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 with nationally. 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. All data relevant to the study are included in the article or uploaded as online supplemental information.

中文翻译：

---

结肠镜癌症检出率：一项新的绩效衡量标准——是否适合目的？

简介 胃肠道症状与癌症诊断的相关性较差。粪便免疫化学检测（FIT）结果≥10 µg对于结直肠癌（CRC）检测具有高灵敏度和阴性预测价值。基于 FIT 的诊断途径可能会带来更有效的资源利用。我们的目的是利用国家内窥镜数据库（NED）数据创建一种新的结肠镜检查性能指标，即癌症检出率（CDR），以评估结肠镜检查目标人群的适当识别；然后使用 CDR 评估在本地实施基于 FIT 的转诊途径的影响。方法 对 NED 数据进行分析，比较 2019 年（途径前修订）和 2021 年（途径后修订）的局部诊断结肠镜 CDR，并以相同时间范围内的全国总体 CDR 为基准。结果 分析了 1、123、624 个 NED 诊断性结肠镜检查。就本地而言，2019年至2021年间CDR显着增加，从3.01%（2.45%–3.47%）增加到4.32%（3.69%–4.95%），p=0.003。 CDR 的增加是由于检测到的 CRC 数量增加了 10%，而诊断性结肠镜检查数量减少了 25%。在全国范围内，CDR 增幅较小，但显着，从 2.02% (1.99%–2.07%) 增加到 2.33% (2.29%–2.37%)，p<0.001。 2019年至2021年CDR%的增幅在当地与全国相比存在显着差异。结论 我们的研究表明，引入经过严格审查的基于 FIT 的算法来确定是否需要诊断性结肠镜检查，可有效提高结肠镜检查 CDR。此外，CDR 似乎是一个有意义的绩效指标，可以通过 NED 自动计算，从而能够监控转诊和审查路径的质量。与研究相关的所有数据都包含在文章中或作为在线补充信息上传。