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A combination of clinical risk stratification and fecal immunochemical test results to prioritize colonoscopy screening in asymptomatic participants.

Abstract：

BACKGROUND:Stool-based colonoscopy is the preferred strategy for colorectal cancer (CRC) screening. The Asia-Pacific Colorectal Screening System (APCS) score also is helpful in stratifying the risk for advanced neoplasia in the asymptomatic population. The combination of the fecal immunochemical test (FIT) result and clinical risk stratification may be more helpful in stratifying the risk. OBJECTIVE:To evaluate the value of the combination of FIT and APCS scores in stratifying asymptomatic participants for colonoscopy. DESIGN:Cross-sectional study. SETTING:University hospital. PATIENTS:A total of 948 asymptomatic participants eligible for screening colonoscopy. INTERVENTIONS:FIT, APCS score evaluation, screening colonoscopy. MAIN OUTCOME MEASUREMENTS:The prevalence of colorectal neoplasia in 4 different groups of participants according to FIT and APCS score evaluations. RESULTS:The prevalence of non-advanced and advanced neoplasia in the 4 groups (high risk with positive FIT result, high risk with negative FIT result, moderate risk with positive FIT result, and moderate risk with negative FIT result) was 44% versus 36.9%, 30.1% versus 11.6%, 27.1% versus 12%, and 22.6% versus 6.4%, respectively (P < .001). Participants with both high-risk scores and positive FIT results had a significantly higher detection rate of advanced neoplasia (6.15-fold, 95% confidence interval, 3.72-10.17) compared with the other 3 groups. Seven cancers were discovered; 4 were in the high-risk with positive FIT result group. LIMITATIONS:Hospital-based study. CONCLUSION:In countries with limited resources, participants with positive FIT results and high-risk scores by APCS should be given priority for colonoscopy because this group is most likely to have advanced neoplasia. However, this strategy needs to be confirmed for its cost-effectiveness in a large, population-based study. ( CLINICAL TRIAL REGISTRATION NUMBER:TCTR20140228001.).

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Aniwan S,Rerknimitr R,Kongkam P,Wisedopas N,Ponuthai Y,Chaithongrat S,Kullavanijaya P

doi

10.1016/j.gie.2014.11.035

subject

Has Abstract

pub_date

2015-03-01 00:00:00

pages

719-27

issue

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(14)02483-3

journal_volume

pub_type

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A combination of clinical risk stratification and fecal immunochemical test results to prioritize colonoscopy screening in asymptomatic participants.