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首页> 外文期刊>Frontline gastroenterology >Systematic analysis of missed colorectal cancer cases and common pitfalls in diagnosis
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Systematic analysis of missed colorectal cancer cases and common pitfalls in diagnosis

机译：漏诊大肠癌病例和常见误区的系统分析

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Background Missed colorectal cancer on endoscopic or radiological investigations may delay diagnosis and impact outcome. This study audits incidence of previous investigations in patients with colorectal cancer, considers outcome in 'missed' cancer cases and examines the diagnostic pathway in the derived case series to identify common pitfalls in diagnosis. Methods Patients diagnosed with colorectal cancer in 2011 at a single National Health Service (NHS) Trust were reviewed. Incidence of endoscopic and radiological investigations in the 3 years preceding diagnosis and outcome data were collected. Cases of prior investigation not leading to diagnosis were considered 'missed' cancers and survival compared with 'detected' cases. The diagnostic pathway in each 'missed' case was reviewed. Results 395 colorectal cancer cases were studied. Eighteen (4.6%) patients underwent previous investigation including colonoscopy (n=4), flexible sigmoidoscopy (n=5), barium enema (n=5) and diagnostic abdominal CT scan (n=12), median 708 days prior to diagnosis. Previous investigation predicted reduced overall and disease-free survival (HR 2.07, p=0.04 and HR 2.66, p<0.0001), after age and gender adjustment. Ten different categories termed 'pitfalls' were derived from analysis of the diagnostic pathway. These included CT scanning for abdominal pain without further investigation (n=7), rectosigmoid cancer following a previous diagnosis of diverticular disease (n=4) and incomplete diagnostic investigations without adequate follow-up (n=3). Conclusions A proportion of patients diagnosed with colorectal cancer have previously been investigated for gastrointestinal symptoms and survival appears reduced in these patients. Regular audit and analysis of previous investigations can identify common pitfalls in diagnosis, which should be used to inform training and improve practice.
机译：背景在内窥镜或放射学检查中遗漏的大肠癌可能会延迟诊断并影响结果。这项研究审核了大肠癌患者先前的调查发生率，考虑了“遗漏”的癌症病例的结局，并检查了衍生病例系列中的诊断途径，以确定常见的诊断隐患。方法对2011年在美国国家卫生服务（NHS）信托基金会诊断为大肠癌的患者进行回顾。收集诊断前3年内镜和放射学检查的发生率，并收集结局数据。与“发现”的病例相比，先前调查未导致诊断的病例被认为是“遗漏”的癌症和生存率。审查了每个“遗漏”病例的诊断途径。结果对395例大肠癌病例进行了研究。十八例（4.6％）患者接受了先前的检查，包括结肠镜检查（n = 4），柔性乙状结肠镜检查（n = 5），钡剂灌肠（n = 5）和诊断性腹部CT扫描（n = 12），中位时间为诊断前708天。先前的研究预测，调整年龄和性别后，总体生存率和无病生存率将降低（HR 2.07，p = 0.04和HR 2.66，p <0.0001）。从诊断途径的分析中得出了十个称为“陷阱”的不同类别。其中包括无需进一步检查就可进行的腹部疼痛的CT扫描（n = 7），先前诊断为憩室病后的直肠乙状结肠癌（n = 4）和没有充分随访的不完整的诊断研究（n = 3）。结论先前已对一部分诊断为大肠癌的患者进行了胃肠道症状调查，发现这些患者的生存期缩短。对以前的调查进行定期审核和分析可以确定诊断中的常见陷阱，应将其用于培训和改进实践。

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