Colonoscopy Findings in FIT+ and mt-sDNA+ patients versus in colonoscopy only patients: New Hampshire Colonoscopy Registry Data
Menée à partir des données du registre des coloscopies de l'Etat du New Hampshire, cette étude analyse le type de lésion détecté à la coloscopie en fonction du test fécal utilisé (test ADN multicible, test FIT, absence de test) puis évalue, du point de vue du taux de détection de néoplasies, l'intérêt de ces tests de dépistage par rapport à une coloscopie seule
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.
Cancer Prevention Research , article en libre accès, 2021