TY - JOUR
T1 - Multitarget Stool DNA Screening in Clinical Practice
T2 - High Positive Predictive Value for Colorectal Neoplasia Regardless of Exposure to Previous Colonoscopy
AU - Eckmann, Jason D.
AU - Ebner, Derek W.
AU - Bering, Jamie
AU - Kahn, Allon
AU - Rodriguez, Eduardo
AU - Devens, Mary E.
AU - Lowrie, Kari L.
AU - Doering, Karen
AU - Then, Sara
AU - Burger, Kelli N.
AU - Mahoney, Douglas W.
AU - Prichard, David O.
AU - Wallace, Michael B.
AU - Gurudu, Suryakanth R.
AU - Finney, Lila J.
AU - Limburg, Paul
AU - Berger, Barry
AU - Ahlquist, David A.
AU - Kisiel, John B.
N1 - Publisher Copyright:
© 2020 by The American College of Gastroenterology.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - 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.
AB - 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.
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U2 - 10.14309/ajg.0000000000000546
DO - 10.14309/ajg.0000000000000546
M3 - Article
C2 - 32068535
AN - SCOPUS:85085980116
SN - 0002-9270
VL - 115
SP - 608
EP - 615
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 4
ER -