Abstract
ObjectivesThe fecal immunochemical test (FIT) has low sensitivity for detecting advanced colorectal neoplasia (ACRN); thus, a considerable portion of FIT-negative persons may have ACRN. We aimed to develop a risk-scoring model for predicting ACRN in FIT-negative persons.Materials and methodsWe reviewed the records of participants aged ≥40 years who underwent a colonoscopy and FIT during a health check-up. We developed a risk-scoring model for predicting ACRN in FIT-negative persons.ResultsOf 11,873 FIT-negative participants, 255 (2.1%) had ACRN. On the basis of the multivariable logistic regression model, point scores were assigned as follows among FIT-negative persons: age (per year from 40 years old), 1 point; current smoker, 10 points; overweight, 5 points; obese, 7 points; hypertension, 6 points; old cerebrovascular attack (CVA), 15 points. Although the proportion of ACRN in FIT-negative persons increased as risk scores increased (from 0.6% in the group with 0–4 points to 8.1% in the group with 35–39 points), it was significantly lower than that in FIT-positive persons (14.9%). However, there was no statistical difference between the proportion of ACRN in FIT-negative persons with ≥40 points and in FIT-positive persons (10.5% vs. 14.9%, P = 0.321).ConclusionsFIT-negative persons may need to undergo screening colonoscopy if they clinically have a high risk of ACRN. The scoring model based on age, smoking habits, overweight or obesity, hypertension, and old CVA may be useful in selecting and prioritizing FIT-negative persons for screening colonoscopy.
Highlights
Colorectal cancer (CRC) is the third most common cancer in men and the second most common in women, and it is the fourth most common cause of cancer deaths worldwide [1]
On the basis of the multivariable logistic regression model, point scores were assigned as follows among fecal immunochemical test (FIT)-negative persons: age, 1 point; current smoker, 10 points; overweight, 5 points; obese, 7 points; hypertension, 6 points; old cerebrovascular attack (CVA), 15 points
FIT-negative persons may need to undergo screening colonoscopy if they clinically have a high risk of advanced colorectal neoplasia (ACRN)
Summary
Colorectal cancer (CRC) is the third most common cancer in men and the second most common in women, and it is the fourth most common cause of cancer deaths worldwide [1]. Many efforts have been made to detect early-stage CRC or its precursor lesions. In advanced colorectal neoplasia (ACRN), which consists of advanced adenoma and CRC, FIT reportedly has low sensitivity, ranging from 27% to 32% [6,7,8,9]. These results suggest that a considerable proportion of persons with ACRN will have a negative FIT result. Given the low sensitivity of FIT for ACRN detection, it may be difficult for physicians to assure that persons with negative results of FIT have no need to undergo screening colonoscopy
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