Abstract
BackgroundFast-track colonoscopy to detect patients with colorectal cancer based on high-risk symptoms is associated with low sensitivity and specificity. The aim was to derive a predictive score of advanced colonic neoplasia in symptomatic patients in fast-track programs.MethodsAll patients referred for fast-track colonoscopy were evaluated. Faecal immunological haemoglobin test (3 samples; positive> 4 μg Hb/g), and a survey to register clinical variables of interest were performed. Colorectal cancer and advanced adenoma were considered as advanced colonic neoplasia. A sample size of 600 and 500 individuals were calculated for each phase 1 and phase 2 of the study, respectively (Phase 1, derivation and Phase 2, validation cohort). A Bayesian logistic regression analysis was used to derive a predictive score.Results1495 patients were included. Age (OR, 21), maximum faecal-Hb value (OR, 2.3), and number of positive samples (OR, 28) presented the highest ORs predictive of advanced colonic neoplasia. The additional significant predictive variables adjusted for age and faecal-Hb variables in Phase 1 were previous colonoscopy (last 5 years) and smoking (no, ex/active). With these variables a predictive score of advanced colonic neoplasia was derived. Applied to Phase 2, patients with a Score > 20 had an advanced colonic neoplasia probability of 66% (colorectal cancer, 32%), while those with a Score ≤ 10, a probability of 10% (colorectal cancer, 1%). Prioritizing patients with Score > 10, 49.4% of patients would be referred for fast-track colonoscopy, diagnosing 98.3% of colorectal cancers and 77% of advanced adenomas.ConclusionsA scoring system was derived and validated to prioritize fast-track colonoscopies according to risk, which was efficient, simple, and robust.
Highlights
Fast-track colonoscopy to detect patients with colorectal cancer based on high-risk symptoms is associated with low sensitivity and specificity
77% of patients with Colorectal cancer (CRC) are referred by primary care physicians via urgent pathways, this system did not improve 5-year colorectal cancer survival [12]
The aim of the study was to derive and validate a predictive risk score to determine the pre-test-probability of advanced colonic neoplasia (ACN) in symptomatic patients with indication of a fast-track colonoscopy
Summary
Fast-track colonoscopy to detect patients with colorectal cancer based on high-risk symptoms is associated with low sensitivity and specificity. Fernández-Bañares et al BMC Cancer (2019) 19:734 to ensure that specialists in reference hospitals assess all patients with suspected CRC within 14 days after urgent referral by a primary care physician. This approach is based on the guidelines of the National Institute for Health and Care Excellence (NICE) criteria for suspected cancer [7]. 77% of patients with CRC are referred by primary care physicians via urgent pathways, this system did not improve 5-year colorectal cancer survival [12] This finding may be due to the fact that the symptoms when present very often indicate an advanced disease, and once a cancer became symptomatic, early treatment did not improve survival. The new NICE guidelines (July 2017) suggest using faecal occult blood test for clinical symptoms associated with a low probability of having CRC (PPV < 3%)
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