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Zorzi M, Battagello J, Amidei CB, Antonelli G, Germanà B, Valiante F, Benvenuti S, Tringali A, Bortoluzzi F, Cervellin E, Giacomin D, Meggiato T, Rizzotto ER, Fregonese D, Dinca M, Baldassarre G, Scalon P, Pantalena M, Milan L, Bulighin G, Di Piramo D, Azzurro M, Gabbrielli A, Repici A, Rugge M, Hassan C. Low Colorectal Cancer Risk After Resection of High-Risk Pedunculated Polyps. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00105-8. [PMID: 38325601 DOI: 10.1016/j.cgh.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Post-fecal immunochemical test (FIT) colonoscopy represents a setting with an enriched prevalence of advanced adenomas. Due to an expected higher risk of colorectal cancer (CRC), postpolypectomy surveillance is recommended, generating a substantially increased load on endoscopy services. The aim of our study was to investigate postpolypectomy CRC risk in a screening population of FIT+ subjects after resection of low-risk adenomas (LRAs) or high-risk adenomas (HRAs). METHODS We retrieved data from a cohort of patients undergoing postpolypectomy surveillance within a FIT-based CRC screening program in Italy between 2002 and 2017 and followed-up to December 2021. Main outcomes were postpolypectomy CRC incidence and mortality risks according to type of adenoma (LRA/HRA) removed at colonoscopy as well as morphology, size, dysplasia, and location of the index lesion. We adopted as comparators FIT+/colonoscopy-negative and FIT- patients. The absolute risk was calculated as the number of incident CRCs per 100,000 person-years of follow-up. We used Cox multivariable regression models to identify associations between CRC risks and patient- and polyp-related variables. RESULTS Overall, we included 87,248 post-FIT+ colonoscopies (133 endoscopists). Of these, 42,899 (49.2%) were negative, 21,650 (24.8%) had an LRA, and 22,709 (26.0%) an HRA. After a median follow-up of 7.25 years, a total of 635 CRCs were observed. For patients with LRAs, CRC incidence (hazard ratio [HR], 1.18; 95% confidence interval [CI], 0.92-1.53) was not increased compared with the FIT+/colonoscopy-negative group, while for HRAs a significant increase in CRC incidence (HR, 1.53; 95% CI, 1.14-2.04) was found. The presence of 1 or more risk factors among proximal location, nonpedunculated morphology, and high-grade dysplasia explained most of this excess CRC risk in the HRA group (HR, 1.85; 95% CI, 1.36-2.52). Patients with only distal pedunculated polyps without high-grade dysplasia, representing 39.2% of HRA, did not have increased risk compared with the FIT- group (HR, 0.87; 95% CI, 0.59-1.28). CONCLUSIONS CRC incidence is significantly higher in patients with HRAs diagnosed at colonoscopy. However, such excess risk does not appear to apply to patients with only distal pedunculated polyps without high-grade dysplasia, an observation that could potentially reduce the burden of surveillance in FIT programs.
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Affiliation(s)
- Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padova, Italy
| | | | | | - Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy; Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Italy.
| | - Bastianello Germanà
- Gastroenterology and Digestive Endoscopy Unit, San Martino Hospital, ULSS 1 Dolomiti, Belluno, Italy
| | - Flavio Valiante
- Gastroenterology and Digestive Endoscopy Unit, Santa Maria del Prato Hospital, ULSS 1 Dolomiti, Feltre, Italy
| | - Stefano Benvenuti
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Alberto Tringali
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 2 Marca Trevigiana, Conegliano, Italy
| | - Francesco Bortoluzzi
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 3 Serenissima, Venice, Italy
| | - Erica Cervellin
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 3 Serenissima, Dolo, Italy
| | - Davide Giacomin
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 4 Veneto Orientale, San Donà di Piave, Italy
| | - Tamara Meggiato
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 5 Rovigo, Rovigo, Italy
| | - Erik Rosa Rizzotto
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 6 Euganea, Padua, Italy
| | - Diego Fregonese
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 6 Euganea, Camposampiero, Italy
| | - Manuela Dinca
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 6 Euganea, Monselice, Italy
| | - Gianluca Baldassarre
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 7 Pedemontana, Santorso, Italy
| | - Paola Scalon
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 7 Pedemontana, Bassano del Grappa, Italy
| | - Maurizio Pantalena
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 8 Berica, Arzignano, Italy
| | - Luisa Milan
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 8 Berica, Vicenza, Italy
| | - Gianmarco Bulighin
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 9 Scaligera, San Bonifacio, Italy
| | - Daniele Di Piramo
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 9 Scaligera, Villafranca, Italy
| | - Maurizio Azzurro
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 9 Scaligera, Legnago, Italy
| | - Armando Gabbrielli
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Alessandro Repici
- Gastroenterology and Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Italy; Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Italy
| | - Massimo Rugge
- Veneto Tumor Registry, Azienda Zero, Padova, Italy; Pathology and Cytopathology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Cesare Hassan
- Gastroenterology and Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Italy; Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Italy
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Hsu WF, Cheng SY, Shun CT, Chang LC, Tu CH, Wang HP, Wu MS, Chiu HM. Higher risk of advanced histology in adenoma less than 10 mm in fecal immunochemical test screening: Implication for management. J Gastroenterol Hepatol 2020; 35:1738-1745. [PMID: 32187748 DOI: 10.1111/jgh.15040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 03/02/2020] [Accepted: 03/15/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM Whether diminutive or small adenomas detected by fecal immunochemical tests (FITs) are associated with a higher risk of advanced histology remains unknown. We investigated the prevalence of advanced histology in diminutive and small adenomas detected by FIT and compared with that detected by colonoscopy screening. METHODS We prospectively compared 1860 FIT-positive patients (FIT-positive cohort) and 6691 average-risk patients (screening colonoscopy cohort). Both groups underwent colonoscopies and were shown to have neoplastic lesions. The prevalence of advanced histology was determined, as was the associations with size and FIT positivity. RESULTS We analyzed 3920 neoplastic lesions from the FIT-positive cohort and 9789 neoplastic lesions from the screening colonoscopy cohort. Eighty (4.3%) diminutive lesions in FIT-positive cohort had advanced histology but without any invasive cancer. Twenty-one patients in the FIT-positive cohort and 49 in the screening colonoscopy cohort with diminutive adenomas displayed advanced histology (3.5% vs 1.2%; adjusted odds ratio [aOR] = 2.99, 95% confidence interval [CI]: 1.77-5.06). Sixteen patients in the FIT-positive cohort (2.7%) with diminutive adenomas might have changed the surveillance interval if a resect-and-discard strategy was applied, with a higher likelihood compared with the screening colonoscopy cohort (aOR = 2.76, 95% CI: 1.53-4.99). CONCLUSIONS Fecal immunochemical test screening detected more diminutive and small adenomas with advanced histology compared with colonoscopy screening. Its impact on current management of diminutive polyp is limited.
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Affiliation(s)
- Wen-Feng Hsu
- Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Shao-Yi Cheng
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Tung Shun
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Chun Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Hung Tu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Sharma T. Analysis of the effectiveness of two noninvasive fecal tests used to screen for colorectal cancer in average-risk adults. Public Health 2020; 182:70-76. [PMID: 32179290 DOI: 10.1016/j.puhe.2020.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/16/2020] [Accepted: 01/30/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States. Although a significant proportion of CRC cases and deaths are preventable by screening, the morbidity and mortality from CRC remains high and is attributed to suboptimal screening rates. Low levels of population CRC screening uptake may be due to reluctance toward invasiveness of some screening tests, embarrassment, exposure to anesthesia, and grueling preparation, especially for the invasive screening tests. Noninvasive tests overcome many of these barriers because they are more convenient and potentially more attractive to patients compared to invasive tests. This study uses Markov cohort simulation model developed with the help of TreeAge pro software to compare two noninvasive fecal CRC screens, fecal immunohistochemical test (FIT) and multitarget stool DNA test (Mt-sDNA) with no screening in order to identify the more effective noninvasive fecal test to screen for colorectal cancer in average-risk adults. STUDY DESIGN Simulation study developed with Markov model using TreeAge pro software, which included a hypothetical cohort at the average risk of developing colorectal cancer. METHODS Markov model was used to compare population-level CRC-related cases and deaths averted, life-years gained (LYG), and colonoscopies required for two noninvasive CRC screening strategies compared with no screening: annual fecal immunohistochemical testing (FIT) and 3-yearly multitarget stool DNA testing (Mt-sDNA). The model simulated the natural history of the adenoma-carcinoma sequence in average-risk persons starting at age 50 years, and natural history parameters were estimated from the literature and via verification to data on precancerous lesions (i.e. adenomas) and CRC incidence. Screening strategies were then superimposed on the natural history component of the model, allowing for precancerous lesions to be detected and removed, or CRC to be detected and treated at a potentially earlier stage. The sensitivity and specificity for each screen for precancerous lesions and CRC were the performance parameters used to estimate the effectiveness. RESULTS Annual FIT was more effective than three yearly Mt-sDNA in reducing CRC cases, averting CRC-related deaths, and increasing the LYG compared to no screening. On average, annual FIT resulted in 3.5 fewer CRC cases, and 2.9 fewer CRC deaths per 1000 persons screened compared to 3-yearly Mt-sDNA. Annual FIT usage resulted in a 0.18 LYG compared to Mt-sDNA, which allowed 0.16 LYG, and an annual FIT screening led to a total of 203 more colonoscopies performed compared to Mt-sDNA. One-way sensitivity analysis conducted over the sensitivity rates of each screen by type of lesion showed that FIT remained the more effective strategy for all ranges of sensitivity. Threshold analysis results identified the lowest FIT sensitivity value at which Mt-sDNA performed better for conventional high-risk adenomas and CRC detection to be 0.16 and 0.052, respectively. CONCLUSION Both the noninvasive screens were effective compared to no screening. Additionally, annual FIT as a first step noninvasive screening test for CRC appears to be more effective compared to three-yearly Mt-sDNA.
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Affiliation(s)
- T Sharma
- Public Health Administration and Policy (PHAP Program), Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.
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Chang LC, Shun CT, Hsu WF, Tu CH, Tsai PY, Lin BR, Liang JT, Wu MS, Chiu HM. Fecal Immunochemical Test Detects Sessile Serrated Adenomas and Polyps With a Low Level of Sensitivity. Clin Gastroenterol Hepatol 2017; 15:872-879.e1. [PMID: 27498176 DOI: 10.1016/j.cgh.2016.07.029] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/28/2016] [Accepted: 07/31/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The serrated pathway is a distinct pathway of colorectal carcinogenesis that has been implicated in development of a substantial proportion of interval colorectal cancers. The fecal immunochemical test (FIT) detects early neoplasms with a higher level of sensitivity than the guaiac test. We investigated the sensitivity of the FIT in detection of sessile serrated adenomas/polyps (SSA/Ps). METHODS We performed a prospective study of 6198 asymptomatic subjects (mean age, 59.0 ± 7.0 years) who received concurrent screening colonoscopies and FITs at the Health Management Center of National Taiwan University Hospital from August 2010 through November 2014. The sensitivity of FIT for conventional adenoma, advanced adenoma, and SSA/P at different cutoffs was calculated, and results were compared by using multivariate analysis adjusted for potential confounders. RESULTS Prevalence values of SSA/P, adenoma, and advanced adenoma were 1.4%, 20.2%, and 5.5%, respectively. At cutoffs of 10, 15, and 20 μg hemoglobin/g feces, the FIT detected all SSA/Ps with 12.3%, 6.2%, and 6.2% sensitivity, large SSA/Ps with 18.4%, 10.5%, and 10.5% sensitivity, and advanced adenomas with 32.4%, 24.5%, and 20.9% sensitivity, respectively. Multivariate analysis revealed that positive results from the FIT did not differ significantly between individuals with SSA/P and those with non-advanced adenoma or those with negative findings from colonoscopy. Patients with large SSA/Ps were less likely to have positive results from the FIT than patients with advanced adenoma, with odds ratios of 0.44 (95% confidence interval [CI], 0.18-1.05), 0.30 (95% CI, 0.10-0.90), and 0.37 (95% CI, 0.12-1.12) at cutoffs of 10, 15, and 20 μg hemoglobin/g feces, respectively, after adjusting for lesion size, even with synchronous conventional adenoma. CONCLUSIONS In a prospective study of 6198 subjects receiving the FIT and colonoscopy, we found that the FIT detected SSA/Ps with significantly lower levels of sensitivity than conventional adenoma. Further studies are needed to determine the effects of these findings on the effectiveness of FIT-based colorectal cancer screening program.
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Affiliation(s)
- Li-Chun Chang
- Department of Internal Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Tung Shun
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Weng-Feng Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chia-Hong Tu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Health Management Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Yu Tsai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Been-Ren Lin
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin-Tung Liang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Health Management Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Health Management Center, National Taiwan University Hospital, Taipei, Taiwan.
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Kim NH, Park JH, Park DI, Sohn CI, Choi K, Jung YS. Risk Factors for False Fecal Immunochemical Test Results in Colorectal Cancer Screening. J Clin Gastroenterol 2017; 51:151-9. [PMID: 27380459 DOI: 10.1097/MCG.0000000000000588] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
GOALS We investigated the factors associated with false fecal immunochemical test (FIT) results for advanced colorectal neoplasm (ACRN). BACKGROUND Data on whether certain subgroups of patients have an increased risk of inaccurate FIT results are extremely limited. STUDY This was a retrospective study conducted in a university hospital in Korea from June 2013 to May 2015. Out of 34,547 participants who had an FIT completed, we analyzed a total of 3990 subjects aged 50 years and above who underwent colonoscopy. RESULTS The rates of false-negative and false-positive results were 58.0% and 15.7%, respectively. Elevated fasting blood glucose [adjusted odds ratio (AOR), 0.59; 95% confidence interval (CI), 0.36-0.97], the presence of high-grade dysplasia (AOR, 0.49; 95% CI, 0.25-0.95), 3 or more adenomas (AOR, 0.56; 95% CI, 0.35-0.89), cancer (AOR, 0.20; 95% CI, 0.11-0.38), and distal ACRN (AOR, 0.61; 95% CI, 0.39-0.96) were associated with a lower risk of false-negative FIT results. The presence of proximal ACRN (AOR, 1.59; 95% CI, 1.01-2.51) and adenoma ≥10 mm (AOR, 4.38; 95% CI, 2.17-8.87) were associated with a higher risk of false-negative results. Older age (70 y and above; AOR, 1.67; 95% CI, 1.29-2.17), diverticulum (AOR, 1.94; 95% CI, 1.45-2.58), and hemorrhoid (AOR, 1.63; 95% CI, 1.32-2.01) were associated with false-positive results. CONCLUSIONS Subjects with a higher risk of false-negative results should be prioritized for earlier colonoscopy and subjects with inaccurate results should be more cautiously considered for screening by using modalities other than FIT. Our findings will contribute to individualization of screening programs.
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