Colonoscopy Findings in FIT+ and mt-sDNA+ Patients versus in Colonoscopy-only Patients: New Hampshire Colonoscopy Registry Data

Abstract

Few studies compare fecal immunochemical test (FIT) and multi-target stool DNA (mt-sDNA) outcomes in practice. We compared colonoscopy yield following FIT+ or mt-sDNA+ tests to colonoscopies without preceding stool tests in the comprehensive population-based New Hampshire Colonoscopy Registry (NHCR). Outcomes were any neoplasia and an ordered outcome: adenocarcinoma, advanced neoplasia (adenoma/serrated polyp {greater than or equal to} 1 cm/villous/high-grade dysplasia), non-advanced neoplasia or normal. Our total sample included 306 mt-sDNA+ (average age +/- SD 67.0 +/- 7.9), 276 FIT+ (66.6 +/- 8.7) and 50,990 colonoscopy-only patients (61.8 +/- 8.1). Among average risk patients (N=240 mt-sDNA+, N=194 FIT+ , N=26,221 colonoscopy only), mt-sDNA+ patients had a higher risk for any neoplasia (67.1%) compared to FIT+ (54.6%, p=0.00098) or colonoscopy (40.8%, p < 0.0001). Severity of findings and histology subtypes differed across the three groups (p<0.0001 for both), with a higher yield of advanced findings in mt-sDNA+ patients. In particular, clinically relevant serrated polyps (hyperplastic polyps {greater than or equal to} 10 mm/traditional serrated adenomas/sessile serrated polyps) were detected at a higher frequency in mt-sDNA+ patients as compared to FIT+ or colonoscopy only patients. Even after adjustment, patients with positive mt-sDNA+ (OR=2.82; 95%CI: 2.00-4.02) or FIT+ tests (OR=1.67; 95% CI: 1.19-2.36) were more likely to have histologically more advanced findings than colonoscopy alone. At follow-up colonoscopy, mt-sDNA+ tests were more likely to predict neoplasia than FIT+, largely due to increased detection of serrated polyps.

Serrated Polyp Yield at Colonoscopy in Patients with Positive FIT, Positive mt-sDNA, and Colonoscopy Only: Data from the New Hampshire Colonoscopy Registry

“…However, a previously published study of our population demonstrated no significant differences for quality measures such as withdrawal time or endoscopist adenoma detection rates between the 3 cohorts which are also used in the current paper. (28) In summary, we observed that in NHCR patients receiving screening tests in the course of routine practice, those with positive mt-sDNA tests were more likely to have serrated polyps detected on subsequent colonoscopy than those with preceding positive FIT tests. Our findings are consistent with prior evidence suggesting that mt-sDNA tests are more likely to identify patients with serrated polyps than FIT tests, and expand on prior work by providing evidence on the types of serrated polyps found in patients after both types of stool tests.…”

“…One additional concern is that there may have been differences with respect to endoscopic evaluation of patients with positive stool tests. However, a previously published study of our population demonstrated no significant differences for quality measures such as withdrawal time or endoscopist adenoma detection rates between the three cohorts which are also used in this article ( 27 ).…”

Sessile serrated polyp detection rates after fecal immunochemical test or multitarget stool DNA test: Systematic review and meta-analysis

“…Our study reports significantly higher rates of SSP and ASP detection rates after positive FIT-DNA as compared to positive FIT testing. Prior observations demonstrate that FIT-DNA has a higher sensitivity for detecting conventional adenomas including advanced adenomas as compared to FIT [35,36,46]. These findings allow information to counsel patients on the utility of one versus the other test.…”

Diagnostic accuracy of the multi-target stool DNA test in detecting colorectal cancer: A hospital-based study

“…In the present study, we recruited 135 participants who all underwent histological or colonoscopy examination, the MT-sDNA test and tumor biomarker detection. We found that the risk score of MT-sDNA was significantly increased in CRC and adenoma patients compared with healthy controls which potentially makes it a promising non-invasive tumor biomarker for CRC detection[ 16 ].…”