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DOI: 10.1055/s-0044-1789011
Adenoma Detection Rate after Positive Stool-Based Screening in a U.S. Population
Funding None declared.Abstract
Introduction and Objectives Over the past two decades, advancements in screening programs have led to a decrease in the incidence and mortality rates of colorectal cancer. The recommended benchmark for primary screening colonoscopy adenoma detection rate (ADR) is 25%. However, recent research supports higher ADR benchmarks following positive stool testing. Findings from a Dutch screening program have suggested higher ADRs in fecal immunochemical test positive patients with an inverse relationship with interval cancer development. Our study aims to assess ADRs in a U.S. patient population with positive stool screenings and investigate any correlation to occurrences of interval cancers.
Materials and Methods Data from all positive stool-based screening participants who subsequently underwent colonoscopy at a tertiary care center between 2017 and 2021 were collected. A retrospective chart review was performed to determine the ADR and interval colon cancers.
Results From a total of 120 patients (32 fecal occult blood test [FOBT] positive patients, 43 fecal immunochemical test [FIT] positive patients, 45 FIT-DNA-positive patients), the average ADR was 35%. Nonadvanced polyps were the most identified adenomas at 78.6%. No interval colorectal cancer cases were identified. There was a clear difference in ADR between stool-testing methods, with FIT-DNA showing higher ADRs than FIT and FOBT.
Conclusion Endoscopists should recognize the importance of higher ADR targets in colonoscopies conducted after positive stool-based screening as a means to maintain high-quality colonoscopy standards.
Keywords
adenoma detection rate - colonoscopy - colorectal cancer - colorectal neoplasms - stool-based screeningPrevious Presentation
American College of Gastroenterology Annual Scientific Meeting in Vancouver, Canada in October 2023.
Statement of Ethics
Approval from the Institutional Review Board was obtained before conducting the chart review.
Author Contributions
T.D. was responsible for planning of the study, collecting and interpreting of data, as well as drafting and editing of the manuscript. R.H. was responsible for collecting data and drafting of the manuscript. S.M.W. was responsible for planning of the study, data analysis, as well as editing of the manuscript. T.L. and J.J. were involved with planning of the study and revision of manuscript. All the authors have approved the final draft of the manuscript submitted.
Publication History
Article published online:
27 August 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Gupta S. Screening for colorectal cancer. Hematol Oncol Clin North Am 2022; 36 (03) 393-414
- 2 Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin 2023; 73 (03) 233-254
- 3 Chan SCH, Liang JQ. Advances in tests for colorectal cancer screening and diagnosis. Expert Rev Mol Diagn 2022; 22 (04) 449-460
- 4 Gross CP, Andersen MS, Krumholz HM, McAvay GJ, Proctor D, Tinetti ME. Relation between Medicare screening reimbursement and stage at diagnosis for older patients with colon cancer. JAMA 2006; 296 (23) 2815-2822
- 5 Rex DK, Boland CR, Dominitz JA. et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2017; 112 (07) 1016-1030
- 6 Kaminski MF, Regula J, Kraszewska E. et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362 (19) 1795-1803
- 7 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49 (04) 378-397
- 8 Corley DA, Jensen CD, Marks AR. et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014; 370 (14) 1298-1306
- 9 Wisse PHA, Erler NS, de Boer SY. et al. Adenoma detection rate and risk for interval postcolonoscopy colorectal cancer in fecal immunochemical test-based screening : a population-based cohort study. Ann Intern Med 2022; 175 (10) 1366-1373
- 10 Rex DK, Petrini JL, Baron TH. et al; ASGE/ACG Taskforce on Quality in Endoscopy. Quality indicators for colonoscopy. Am J Gastroenterol 2006; 101 (04) 873-885
- 11 Issa IA, Noureddine M. Colorectal cancer screening: an updated review of the available options. World J Gastroenterol 2017; 23 (28) 5086-5096
- 12 Wong JCT, Chiu HM, Kim HS. et al; Asia-Pacific Working Group on Colorectal Cancer. Adenoma detection rates in colonoscopies for positive fecal immunochemical tests versus direct screening colonoscopies. Gastrointest Endosc 2019; 89 (03) 607-613.e1
- 13 Denis B, Gendre I, Tuzin N. et al. Adenoma detection rate is enough to assess endoscopist performance: a population-based observational study of FIT-positive colonoscopies. Endosc Int Open 2022; 10 (09) E1208-E1217
- 14 Mohan BP, Khan SR, Daugherty E. et al. Pooled rates of adenoma detection by colonoscopy in asymptomatic average-risk individuals with positive fecal immunochemical test: a systematic review and meta-analysis. Gastrointest Endosc 2022; 96 (02) 208-222.e14
- 15 Robertson DJ, Lee JK, Boland CR. et al. Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2017; 152 (05) 1217-1237.e3
- 16 Jover R, Herráiz M, Alarcón O. et al; Spanish Society of Gastroenterology, Spanish Society of Gastrointestinal Endoscopy Working Group. Clinical practice guidelines: quality of colonoscopy in colorectal cancer screening. Endoscopy 2012; 44 (04) 444-451
- 17 Waldmann E, Kammerlander AA, Gessl I. et al. Association of adenoma detection rate and adenoma characteristics with colorectal cancer mortality after screening colonoscopy. Clin Gastroenterol Hepatol 2021; 19 (09) 1890-1898
- 18 Wolf AMD, Fontham ETH, Church TR. et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin 2018; 68 (04) 250-281
- 19 Young GP, Symonds EL, Allison JE. et al. Advances in fecal occult blood tests: the FIT revolution. Dig Dis Sci 2015; 60 (03) 609-622
- 20 Imperiale TF, Ransohoff DF, Itzkowitz SH. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med 2014; 371 (02) 187-188
- 21 Adler A, Geiger S, Keil A. et al. Improving compliance to colorectal cancer screening using blood and stool based tests in patients refusing screening colonoscopy in Germany. BMC Gastroenterol 2014; 14: 183
- 22 Heckroth M, Eiswerth M, Elmasry M. et al. Serrated polyp detection rate in colonoscopies performed by gastrointestinal fellows. Ther Adv Gastrointest Endosc 2022; 15: 26 317745221136775
- 23 Huang J, Chan PSF, Pang TWY. et al. Rate of detection of serrated lesions at colonoscopy in an average-risk population: a meta-analysis of 129,001 individuals. Endosc Int Open 2021; 9 (03) E472-E481
- 24 Garg R, Burke CA, Aggarwal M. et al. Sessile serrated polyp detection rates after fecal immunochemical test or multitarget stool DNA test: systematic review and meta-analysis. Endosc Int Open 2024; 12 (04) E474-E487