结肠癌（CRC）筛查计划基于粪便免疫化学试验（FIT）是面向人群的干预的标准护理。它们的效益取决于FIT阳性后结肠镜检测出肿瘤。腺瘤检测率（ADR）用于衡量结肠镜检测质量，可能影响筛查计划的有效性。本研究旨在研究ADR与FIT筛查计划中结肠镜检测后结肠直肠癌（PCCRC）风险的关联。研究采用回顾性面向人群的队列研究。本地范围2003年至2021年的FIT筛查计划。包括所有接受结肠镜检测的FIT阳性患者。区域癌症登记处提供了结肠镜检测后6个月到10年之间所有被诊断出的PCCRC的信息。将内窥镜检查者的ADR分为5组（20％至39.9％，40％至44.9％，45％至49.9％，50％至54.9％和55％至70％）。为了检验ADR与PCCRC发病风险之间的关联，使用Cox回归模型来估计风险比（HR）和95％置信区间（CI）。在110109次初步结肠镜检测中，包括2012年至2017年由113名内窥镜检查者完成的49626次结肠镜检测。经过328778个人年的随访，诊断出277例PCCRC。平均ADR为48.3％（范围为23％至70％）。PCCRC的发病率从ADR最低组到ADR最高组分别为10,000人年13.13、10.61、7.60、6.01和5.78。在ADR最低组与ADR最高组之间存在显著的逆向关联，风险增加2.35倍（95％CI，1.63至3.38）。与ADR 1％增加相关的PCCRC的调整HR为0.96（CI，0.95至0.98）。ADR部分由FIT阳性截止值决定；在不同环境中可能存在不同的确切值。在FIT筛查计划中，ADR与PCCRC发病风险呈逆向关联，需要适当监测结肠镜检查的质量。提高内窥镜检查者的ADR可以显著降低PCCRC的风险。本研究无任何冲突。

Colorectal cancer (CRC) screening programs based on fecal immunochemical tests (FITs) represent the standard of care for population-based interventions. Their benefit depends on the identification of neoplasia at colonoscopy after FIT positivity. Colonoscopy quality measured by adenoma detection rate (ADR) may affect screening program effectiveness.To examine the association between ADR and postcolonoscopy CRC (PCCRC) risk in a FIT-based screening program.Retrospective population-based cohort study.Fecal immunochemical test-based CRC screening program between 2003 and 2021 in northeastern Italy.All patients with a positive FIT result who had a colonoscopy were included.The regional cancer registry supplied information on any PCCRC diagnosed between 6 months and 10 years after colonoscopy. Endoscopists' ADR was categorized into 5 groups (20% to 39.9%, 40% to 44.9%, 45% to 49.9%, 50% to 54.9%, and 55% to 70%). To examine the association of ADR with PCCRC incidence risk, Cox regression models were fitted to estimate hazard ratios (HRs) and 95% CIs.Of the 110 109 initial colonoscopies, 49 626 colonoscopies done by 113 endoscopists between 2012 and 2017 were included. After 328 778 person-years follow-up, 277 cases of PCCRC were diagnosed. Mean ADR was 48.3% (range, 23% and 70%). Incidence rates of PCCRC from lowest to highest ADR group were 13.13, 10.61, 7.60, 6.01, and 5.78 per 10 000 person-years. There was a significant inverse association between ADR and PCCRC incidence risk, with a 2.35-fold risk increase (95% CI, 1.63 to 3.38) in the lowest group compared with the highest. The adjusted HR for PCCRC associated with 1% increase in ADR was 0.96 (CI, 0.95 to 0.98).Adenoma detection rate is partly determined by FIT positivity cutoff; exact values may vary in different settings.In a FIT-based screening program, ADR is inversely associated with PCCRC incidence risk, mandating appropriate colonoscopy quality monitoring in this setting. Increasing endoscopists' ADR may significantly reduce PCCRC risk.None.