{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T01:18:20Z","timestamp":1789089500494,"version":"build-2803163510"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Colorectal Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>This study aimed to evaluate the proportion of colorectal cancer (CRC) missed by colonoscopy and the characteristics of the patients with missed diagnosis using data from the prostate, lung, colorectal, and ovarian (PLCO) cancer screening trial, and to analyze and compare patient survival between detection and missed diagnosis groups for an evidence-based basis for improving the effectiveness of colorectal cancer screening.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patients and methods<\/jats:title>\n            <jats:p>Patients with CRC identified by baseline or follow-up colonoscopy and those identified by annual study update questionnaires or National Death Index search, without any positive findings by colonoscopy in the screening arm of the PLCO study, were included in this study. We calculated the rate of missed CRC diagnosis by colonoscopy using the definition of missed cases as the numerator and the sum of patients with CRC as the denominator.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Three hundred sixty patients with CRC were included in the final analysis (detection group, <jats:italic>n<\/jats:italic>\u2009=\u2009298; missed diagnosis group, <jats:italic>n<\/jats:italic>\u2009=\u200962). The overall rate of missed CRC diagnosis by colonoscopy was 17.22%. Patients with a history of colorectal polyps had a higher rate of missed diagnoses (33.3%). The missed diagnosis rate was higher in patients with proximal CRC (31.3%). CRC occurring in the transverse colon (29.6%), hepatic flexure of the colon (40.0%), ascending colon (27.0%), and cecum (36.6%) were more likely to be missed by colonoscopy. The later the stage, the higher the missed CRC diagnosis rate (10.5, 20.0, 30.8, and 30.8% for stages I\u2013IV, respectively).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Colonoscopy missed a relatively high proportion of CRC, mainly in the proximal colon (especially in the hepatic flexure and cecum of the colon). Recent developments in non-invasive screening technologies, such as stool DNA testing and liquid biopsy, may help address the limitations of colonoscopy. Combining these approaches with traditional endoscopy could enhance overall detection accuracy and reduce the rate of missed colorectal cancer.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00384-025-04952-4","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:10:29Z","timestamp":1759450229000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Missed colorectal cancer diagnosis by screening colonoscopy based on the PLCO cancer screening trial"],"prefix":"10.1007","volume":"40","author":[{"given":"Ying","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tongzhou","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuying","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longjun","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wencheng","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofang","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilv","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanbo","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianjun","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"issue":"1","key":"4952_CR1","first-page":"7","volume":"70","author":"RL Siegel","year":"2020","unstructured":"Siegel RL, Miller KD (2020) Jemal A (2020) Cancer statistics. CA Cancer J Clin 70(1):7\u201330","journal-title":"CA Cancer J Clin"},{"issue":"12","key":"4952_CR2","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1080\/14737140.2017.1392243","volume":"17","author":"M Maida","year":"2017","unstructured":"Maida M, Macaluso FS, Ianiro G, Mangiola F, Sinagra E, Hold G, Maida C, Cammarota G, Gasbarrini A, Scarpulla G (2017) Screening of colorectal cancer: present and future. Expert Rev Anticancer Ther 17(12):1131\u20131146","journal-title":"Expert Rev Anticancer Ther"},{"key":"4952_CR3","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.ypmed.2018.10.021","volume":"118","author":"RB Issaka","year":"2019","unstructured":"Issaka RB, Avila P, Whitaker E, Bent S, Somsouk M (2019) Population health interventions to improve colorectal cancer screening by fecal immunochemical tests: a systematic review. Prev Med 118:113\u2013121","journal-title":"Prev Med"},{"issue":"4","key":"4952_CR4","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1053\/j.gastro.2017.11.025","volume":"154","author":"DS Weinberg","year":"2018","unstructured":"Weinberg DS, Pickhardt PJ, Bruining DH, Edwards K, Fletcher JG, Gollub MJ, Keenan EM, Kupfer SS, Li T, Lubner SJ et al (2018) Computed tomography colonography vs colonoscopy for colorectal cancer surveillance after surgery. Gastroenterology 154(4):927-934.e924","journal-title":"Gastroenterology"},{"issue":"11","key":"4952_CR5","first-page":"2105","volume":"43","author":"T Offermans","year":"2017","unstructured":"Offermans T, Vogelaar FJ, Aquarius M, Janssen-Heijnen MLG, Simons PCG (2017) Preoperative segmental localization of colorectal carcinoma: CT colonography vs. optical colonoscopy. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 43(11):2105\u20132111","journal-title":"Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol"},{"issue":"8","key":"4952_CR6","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1056\/NEJMoa1100370","volume":"366","author":"AG Zauber","year":"2012","unstructured":"Zauber AG, Winawer SJ, O\u2019Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, Shi W, Bond JH, Schapiro M, Panish JF et al (2012) Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 366(8):687\u2013696","journal-title":"N Engl J Med"},{"issue":"6","key":"4952_CR7","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1016\/S1470-2045(17)30187-0","volume":"18","author":"W Atkin","year":"2017","unstructured":"Atkin W, Wooldrage K, Brenner A, Martin J, Shah U, Perera S, Lucas F, Brown JP, Kralj-Hans I, Greliak P et al (2017) Adenoma surveillance and colorectal cancer incidence: a retrospective, multicentre, cohort study. Lancet Oncol 18(6):823\u2013834","journal-title":"Lancet Oncol"},{"key":"4952_CR8","doi-asserted-by":"crossref","unstructured":"Clark BT, Protiva P, Nagar A, Imaeda A, Ciarleglio MM, Deng Y, Laine L (2016) Quantification of adequate bowel preparation for screening or surveillance colonoscopy in men. Gastroenterology 150(2):396\u2013405. quiz e314\u2013395","DOI":"10.1053\/j.gastro.2015.09.041"},{"issue":"6","key":"4952_CR9","doi-asserted-by":"publisher","first-page":"1661","DOI":"10.1053\/j.gastro.2019.01.260","volume":"156","author":"S Zhao","year":"2019","unstructured":"Zhao S, Wang S, Pan P, Xia T, Chang X, Yang X, Guo L, Meng Q, Yang F, Qian W et al (2019) Magnitude, risk factors, and factors associated with adenoma miss rate of tandem colonoscopy: a systematic review and meta-analysis. Gastroenterology 156(6):1661-1674.e1611","journal-title":"Gastroenterology"},{"issue":"9","key":"4952_CR10","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1111\/jgh.14674","volume":"34","author":"KS Cheung","year":"2019","unstructured":"Cheung KS, Chen L, Seto WK, Leung WK (2019) Epidemiology, characteristics, and survival of post-colonoscopy colorectal cancer in Asia: a population-based study. J Gastroenterol Hepatol 34(9):1545\u20131553","journal-title":"J Gastroenterol Hepatol"},{"issue":"1","key":"4952_CR11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.medcli.2017.04.015","volume":"150","author":"M Mu\u00f1oz Garc\u00eda-Borruel","year":"2018","unstructured":"Mu\u00f1oz Garc\u00eda-Borruel M, Herv\u00e1s Molina AJ, Rodr\u00edguez Per\u00e1lvarez ML, Moreno Rinc\u00f3n E, P\u00e9rez Medrano I, Serrano Ruiz FJ, Cas\u00e1is Juanena LL, Pleguezuelo Navarro M, Naranjo Rodr\u00edguez A, Villar Pastor C (2018) Post-colonoscopy colorectal cancer: characteristics and predictive factors. Med Clin 150(1):1\u20137","journal-title":"Med Clin"},{"issue":"1","key":"4952_CR12","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1186\/s12885-018-4375-9","volume":"18","author":"MES Bronzwaer","year":"2018","unstructured":"Bronzwaer MES, Greuter MJE, Bleijenberg AGC, JEG IJ, Dekker E, Coup\u00e9 VMH (2018) Impact of differences in adenoma and proximal serrated polyp detection rate on the long-term effectiveness of FIT-based colorectal cancer screening. BMC Cancer 18(1):465","journal-title":"BMC Cancer"},{"issue":"6 Suppl","key":"4952_CR13","doi-asserted-by":"publisher","first-page":"251s","DOI":"10.1016\/S0197-2456(00)00097-0","volume":"21","author":"JK Gohagan","year":"2000","unstructured":"Gohagan JK, Prorok PC, Hayes RB, Kramer BS (2000) The prostate, lung, colorectal and ovarian (PLCO) cancer screening trial of the National Cancer Institute: history, organization, and status. Control Clin Trials 21(6 Suppl):251s\u2013272s","journal-title":"Control Clin Trials"},{"issue":"3","key":"4952_CR14","doi-asserted-by":"publisher","first-page":"238","DOI":"10.2174\/157488711003150928130654","volume":"10","author":"A Black","year":"2015","unstructured":"Black A, Huang WY, Wright P, Riley T, Mabie J, Mathew S, Ragard L, Hermansen S, Yu K, Pinsky P et al (2015) PLCO: evolution of an epidemiologic resource and opportunities for future studies. Rev Recent Clin Trials 10(3):238\u2013245","journal-title":"Rev Recent Clin Trials"},{"issue":"7","key":"4952_CR15","doi-asserted-by":"publisher","first-page":"2063","DOI":"10.1007\/s10620-019-05912-z","volume":"65","author":"JH Park","year":"2020","unstructured":"Park JH, Moon HS, Kwon IS, Kim JS, Kang SH, Lee ES, Kim SH, Sung JK, Lee BS, Jeong HY (2020) Quality of preoperative colonoscopy affects missed postoperative adenoma detection in colorectal cancer patients. Dig Dis Sci 65(7):2063\u20132070","journal-title":"Dig Dis Sci"},{"key":"4952_CR16","doi-asserted-by":"crossref","unstructured":"Pai RK, Bettington M, Srivastava A, Rosty C (2019) An update on the morphology and molecular pathology of serrated colorectal polyps and associated carcinomas. Mod Pathol Off J U. S. Can Acad Pathol, Inc 32(10):1390\u20131415","DOI":"10.1038\/s41379-019-0280-2"},{"issue":"3","key":"4952_CR17","doi-asserted-by":"publisher","first-page":"612","DOI":"10.1016\/j.gie.2011.10.024","volume":"75","author":"RE Schoen","year":"2012","unstructured":"Schoen RE, Pinsky PF, Weissfeld JL, Yokochi LA, Church T, Laiyemo AO, Bresalier R, Hickey T, Riley T, Prorok PC (2012) Colorectal cancers not detected by screening flexible sigmoidoscopy in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Gastrointest Endosc 75(3):612\u2013620","journal-title":"Gastrointest Endosc"},{"issue":"5","key":"4952_CR18","first-page":"583","volume":"31","author":"E Rodrigues-Pinto","year":"2019","unstructured":"Rodrigues-Pinto E, Ferreira-Silva J, Macedo G, Rex DK (2019) (Technically) Difficult colonoscope insertion - tips and tricks. Dig Endosc Off J Japan Gastroenterol Endosc Soc 31(5):583\u2013587","journal-title":"Dig Endosc Off J Japan Gastroenterol Endosc Soc"},{"issue":"2","key":"4952_CR19","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1053\/j.gastro.2024.03.011","volume":"167","author":"U Ladabaum","year":"2024","unstructured":"Ladabaum U, Mannalithara A, Weng Y, Schoen RE, Dominitz JA, Desai M, Lieberman D (2024) Comparative effectiveness and cost-effectiveness of colorectal cancer screening with blood-based biomarkers (liquid biopsy) vs fecal tests or colonoscopy. Gastroenterology 167(2):378\u2013391","journal-title":"Gastroenterology"},{"issue":"19","key":"4952_CR20","doi-asserted-by":"publisher","first-page":"3128","DOI":"10.1158\/0008-5472.CAN-24-1620","volume":"84","author":"C Rolfo","year":"2024","unstructured":"Rolfo C, Russo A (2024) The next frontier for colorectal cancer screening: blood-based tests. Cancer Res 84(19):3128\u20133129","journal-title":"Cancer Res"},{"issue":"1","key":"4952_CR21","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1002\/lary.30781","volume":"134","author":"SX Wang","year":"2024","unstructured":"Wang SX, Li Y, Zhu JQ, Wang ML, Zhang W, Tie CW, Wang GQ, Ni XG (2024) The detection of nasopharyngeal carcinomas using a neural network based on nasopharyngoscopic images. Laryngoscope 134(1):127\u2013135","journal-title":"Laryngoscope"},{"issue":"2","key":"4952_CR22","doi-asserted-by":"publisher","first-page":"204","DOI":"10.5009\/gnl15420","volume":"10","author":"JR Bailey","year":"2016","unstructured":"Bailey JR, Aggarwal A, Imperiale TF (2016) Colorectal cancer screening: stool DNA and other noninvasive modalities. Gut and liver 10(2):204\u2013211","journal-title":"Gut and liver"}],"container-title":["International Journal of Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00384-025-04952-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00384-025-04952-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00384-025-04952-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:10:31Z","timestamp":1759450231000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00384-025-04952-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,3]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4952"],"URL":"https:\/\/doi.org\/10.1007\/s00384-025-04952-4","relation":{},"ISSN":["1432-1262"],"issn-type":[{"value":"1432-1262","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,3]]},"assertion":[{"value":"6 July 2025","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 October 2025","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"206"}}