Multitarget Stool DNA Screening in Clinical Practice: High Positive Predictive Value for Colorectal Neoplasia Regardless of Exposure to Previous Colonoscopy
| Autor: | David O. Prichard, Eduardo A. Rodriguez, Sara Then, Kelli N. Burger, Douglas W. Mahoney, Kari L. Lowrie, Allon Kahn, Lila J. Finney, Jamie Bering, Jason D. Eckmann, David A. Ahlquist, John B. Kisiel, Karen A. Doering, Derek Ebner, Mary E. Devens, Paul J. Limburg, Barry M. Berger, Michael B. Wallace, Suryakanth R. Gurudu |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Colon Colorectal cancer Colonoscopy Gastroenterology Article Feces 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Internal medicine medicine Humans Mass Screening Stool dna Early Detection of Cancer Aged Retrospective Studies Hepatology medicine.diagnostic_test business.industry Retrospective cohort study DNA Neoplasm Middle Aged medicine.disease Predictive value Clinical Practice Increased risk 030220 oncology & carcinogenesis Predictive value of tests Female 030211 gastroenterology & hepatology Colorectal Neoplasms business Precancerous Conditions |
| Zdroj: | The American Journal of Gastroenterology |
| ISSN: | 1572-0241 0002-9270 |
| DOI: | 10.14309/ajg.0000000000000546 |
| Popis: | OBJECTIVES: Multitarget stool DNA (MT-sDNA) testing has grown as a noninvasive screening modality for colorectal cancer (CRC), but real-world clinical data are limited in the post-FDA approval setting. The effect of previous colonoscopy on MT-sDNA performance is not known. We aimed to evaluate findings of colorectal neoplasia (CRN) at diagnostic colonoscopy in patients with positive MT-sDNA testing, stratified by patient exposure to previous colonoscopy. METHODS: We identified consecutive patients completing MT-sDNA testing over a 39-month period and reviewed the records of those with positive tests for neoplastic findings at diagnostic colonoscopy. MT-sDNA test positivity rate, adherence to diagnostic colonoscopy, and the positive predictive value (PPV) of MT-sDNA for any CRN and neoplastic subtypes were calculated. RESULTS: Of 16,469 MT-sDNA tests completed, testing returned positive in 2,326 (14.1%) patients. After exclusion of patients at increased risk for CRC, 1,801 patients remained, 1,558 (87%) of whom underwent diagnostic colonoscopy; 918 of 1,558 (59%) of these patients had undergone previous colonoscopy, whereas 640 (41%) had not. Any CRN was found in 1,046 of 1,558 patients (PPV = 67%). More neoplastic lesions were found in patients without previous colonoscopy (73%); however, the rates remained high among those who had undergone previous colonoscopy (63%, P < 0.0001). The large majority (79%) of patients had right-sided neoplasia. DISCUSSION: MT-sDNA has a high PPV for any CRN regardless of exposure to previous colonoscopy. Right-sided CRN was found at colonoscopy in most patients with positive MT-sDNA testing, representing a potential advantage over other currently available screening modalities for CRC. |
| Databáze: | OpenAIRE |
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