BACKGROUND The multi-target stool DNA test (MT-sDNA) has potential utility in the detection of colorectal cancer (CRC), but validation of its clinical accuracy has been limited in China. AIM To evaluate the diagnostic performance of MT-sDNA and investigate the combined diagnostic value of alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), and carbohydrate antigen 199 (CA199) with MT-sDNA in CRC and adenomas. METHODS We evaluated the performance of the MT-sDNA kit based on a hospital clinical trial. In this case-control study, 135 participants from the Affiliated Hospital of Medical School of Ningbo University, including 51 CRC patients, 23 patients with adenomas, and 61 healthy controls were enrolled. We used a risk scoring system to determine the positivity of tests with histological diagnosis or colonoscopy as the reference standard. RESULTS The main indices of sensitivity, specificity and accuracy were evaluated. The sensitivity and specificity for CRC detection were 90.2% and 83.3%, respectively, with an accuracy of 89.8%. For adenoma, the sensitivity and specificity were 56.5% and 68.9%, respectively, with an accuracy of 73.1%. The sensitivity and specificity of MT-sDNA combined with CEA in the diagnosis of adenoma were 78.3% and 60.7%, respectively. CONCLUSION The MT-sDNA test showed better performance in the detection of CRC, which was superior to AFP, CEA, and CA199 separately, but not for predicting adenomas. The combination of MT-sDNA with CEA further improved the sensitivity for adenoma diagnosis.

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Background Multi-target stool DNA (MT-sDNA) test can reduce colorectal cancer (CRC) incidence and mortality as a simple, noninvasive screening method. It is crucial to understand people's willingness to accept and willingness to pay for MT-sDNA test for CRC screening. Methods A hospital-based study was conducted in the affiliated hospital of medical school of Ningbo University in southeastern China between June 2021 to March 2022. Individuals aged ≥ 40 years from outpatient department, endoscopy center and inpatient department were included. All participants completed a questionnaire to collect detailed information by a face-to-face interview. Characteristics of individuals were described using frequency and percentage. Group comparisons were performed with chi-square test for categorical variable. Multivariate logistic regression analyses were performed to estimate the associations of social-demographic characteristics, lifestyle factors, CRC risk and medical history with screening intention. Results Of the 977 participants who completed the interview, 85.06% were willing to accept MTs-DNA test for CRC screening, 82.29% were willing to pay for it. Individuals came from non outpatient source (OR = 3.16, 95% CI: 2.14, 4.68), with moderate risk of CRC (OR = 1.66, 95% CI: 1.10, 2.52) were more likely to accept MTs-DNA test for CRC screening. Those came from non outpatient source (OR = 2.56, 95% CI: 1.79, 3.67), with moderate risk of CRC (OR = 1.98, 95% CI: 1.34, 2.91), with history of polypectomy (OR = 2.20, 95% CI: 1.31, 3.68) and with middle/high school education and graduated from college or above (OR = 1.62, 95% CI: 1.07, 2.46, OR = 2.67, 95% CI: 1.27, 5.60, respectively) were more willing to pay for MTs-DNA test for CRC screening. Conclusion The present study found that individuals from non outpatient source, with moderate risk of CRC, with higher education and history of polypectomy were more likely to accept MTs-DNA test or pay for it. It is worth noting that individuals with high risk of CRC were less likely to accept MTs-DNA test and pay for it. Health education interventions should be developed to emphasise the significance of screening and introduce the simple, noninvasive MT-sDNA test to the public, especially those with above characteristics.