FIT-positive Patients Research Articles

Prevalence and endoscopic features of colorectal non-polypoid lesions: a single-center retrospective study from a large cohort of FIT-positive screening patients in Northern Italy.

Colorectal non-polypoid lesions (NPLs) are flat, hard-to-detect and mainly right-sided lesions. We aimed to assess the prevalence and endoscopic features of NPLs lesions in a large cohort of screening patients in Northern Italy. FIT-positive subjects between 50 and 69 years old who had undergone at least a screening colonoscopy from March 2005 to December 2017 at the Endoscopy Unit of Ferrara were included. We selected only non-diminutive (>5 mm) and neoplastic polyps (i.e.: adenomas, serrated adenomas and carcinomas). Patients' demographics and polyps' endoscopic-histopathological data were collected. Categorical variables were compared using the Pearson's χ2 test and Fisher's Exact Test, while odd Ratios and confidence intervals were estimated with univariate analysis. 6,676 FIT-positive subjects underwent 7,616 colonoscopies during the study period. Total lesions were 3,231, of which 133 were NPLs and among these 123 were neoplastic. Prevalence of NPLs among total lesions was 4.1% while prevalence of neoplastic NPLs among total neoplastic lesions was 4.6%. Prevalence of NPLs and neoplastic NPLs among total colonoscopies was 1.7% and 1.6%, respectively. Neoplastic NPLs were more frequent between 60 and 64 years old (p=0.03) and associated with other colonic polyps in subjects older than 60 years (p=0.016). Cancerized NPLs were more likely in younger patients (50-59 years old, p=0.04). Prevalence of NPLs is low among screening population, but NPLs are frequently associated with other colonic polyps in patients older than 60 years and carry a higher risk of cancer in patients younger than 60 years old.

Faecal Immunochemical Test (FIT) Value-Based Algorithm to Triage Symptomatic Colorectal Patients: A Retrospective Study From a Tertiary Care Hospital.

Background The aim was to evaluate the diagnostic accuracy of quantitative faecal immunochemical testing (FIT) in diagnosing colorectal cancer in symptomatic patients and using it to prioritize patients for urgent colorectal investigations. Methods A retrospective review was done of all symptomatic, FIT-positive patients referred from primary care to the colorectal clinic as per the National Institute for Health and Care Excellence (NICE) DG30 pathway from November 1, 2021, to February 11, 2022. Patients under 18 years of age were excluded. All patients were triaged to test (TTT) or booked in face-to-face (F2F) clinics according to a local algorithm. The data was collected in Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States), and statistical analysis was performed using IBM SPSS Statistics for Windows (IBM Corp., Armonk, New York, United States). Results Out of 915 FIT-positive patients, 774 (84.5%) patients were TTT and 70 (7.65%) were booked in F2F clinics. The mean age was 71 years, and the majority were females (n=488 (F:M = 53:47)). However, a higher prevalence of positive FIT test was observed in men than in women at higher cut-off values of >100 and >200 μg Hb/g faeces (18.79 % vs 17.48% and 12.78% vs 11.69%, respectively). The number needed to scope was 10.8, 6.03, and 5.20 at cut-off values of ≥10, >100, and >200 μg Hb/g, respectively. At cut-off values of ≥10, >100, and >200 μg Hb/g, the specificity for colorectal cancer (CRC) with a 95% confidence interval (95% CI) was 63.75 %, 88.10%, and 92.27 %, respectively, and the positive predictive value (PPV) was 9.63, 18.20, and 21.24, respectively. The majority of the patients (30.9%) had no pathology on colonoscopy, whereas CRC was detected in 9.8%. Conclusion Quantitative FIT in symptomatic colorectal patients can be used to triage patients to investigations more appropriately, reducing the burden on outpatient and endoscopy units and improving the overall efficacy of health provision.

Assessing the Role of Flexible Sigmoidoscopy for Patients With Positive Fecal Immunochemical Test (FIT) and Rectal Bleeding as a Sole Symptom Within the Fast-Track Pathway.

Background Rectal bleeding is a frequent symptom, with causes ranging from benign conditions to serious diseases like colorectal cancer (CRC) and inflammatory bowel disease (IBD). In the UK, the two-week wait (2WW) referral pathway, which includes the fecal immunochemical test (FIT), plays a key role in triaging suspected CRC cases. This study evaluates the effectiveness of flexible sigmoidoscopy (FS) in detecting significant bowel pathologies (SBPs) in FIT-positive patients with isolated rectal bleeding. Methods We reviewed records of 344 patients with isolated rectal bleeding and a positive FIT result, referred to the 2WW pathway at York and Scarborough Teaching Hospitals NHS Foundation Trust from February to December 2023. All patients underwent colonoscopy. Findings from colonoscopy were used as a standard to compare with the expected reach of FS. Pathologies were categorized into SBPs (cancer, IBD, polyps ≥10 mm) and non-SBPs, and the location of SBPs in relation to the splenic flexure was also assessed. Results The average age of patients was 61.58 years. Significant bowel pathology (SBP) was identified in 89 of 344 (25.9%) patients, including 16 (18%) patients with cancer, 21 (23.6%) patients with IBD, and 52 (58.4%) patients with large polyps. All cases of cancer and IBD were found distal to the splenic flexure, while 21.1% (11/89) of large polyps were proximal. Higher FIT values (>100 µg Hb/g feces) and older age were significantly associated with SBPs. However, age and higher FIT values did not predict whether SBPs were proximal or distal. Conclusion For FIT-positive patients with isolated rectal bleeding, FS can serve as an effective initial diagnostic tool. Patients without detected cancer can be downgraded from the fast-track pathway to routine colonoscopy follow-up to avoid missing proximal premalignant lesions. This approach enhances resource utilization while ensuring comprehensive patient care. Further studies are needed to improve triage criteria and diagnostic accuracy within the 2WW pathway.

Electronic Coding for Abnormal Fecal Immunochemical Test Is Associated With Increased Colonoscopy Completion.

We examined the utility of the International Classification of Disease, Tenth Revision (ICD-10) code, R19.5, for a positive or abnormal fecal immunochemical test (FIT) and its association with colonoscopy completion. We identified all patients in a safety-net health system who underwent FITs from January 1, 2020, to August 31, 2021, and extracted the FIT date, FIT result, and ICD-10 code (R19.5) and colonoscopy procedures for each patient. FIT-positive patients who had an R19.5 designation within 90 days (n = 383) were significantly more likely than all other FIT-positive patients (n = 273) to complete a colonoscopy within 6 months (40.9% vs 16.8%, P <0.001). We found that less than two-thirds of patients had an ICD-10 code designated in their chart within 30 days of an abnormal FIT. When coding occurred in a timely manner, patients were more likely to complete their colonoscopy within 6 months.

2002 An observational study of the effectiveness of FIT test as a risk stratification tool in frail patients presenting with anaemia

Abstract Introduction Faecal-immunochemical-test is employed as a screening tool for colorectal cancer. Our observational study examined the FIT in primary care as a risk stratification tool in frail patients. Method The records of 217 frail patients over a 24-month period were analysed. Patients with haematological indices of anaemia were offered FIT to detect GI haemorrhage as part of assessment for selection for lower GI investigations. Patients were risk stratified based on FIT results based on the presence or absence of red flags. Patients who were FIT positive were referred for urgent lower GI endoscopy versus those who were FIT negative were managed without bowel investigations unless there were red flags such as abdominal mass, changed bowel habits or family history of bowel cancer. Results Of 217 patients over a 24-month period of these 42 patients (19.4%) were FIT positive. All of these (n = 42) underwent colonoscopy of which 15 (normal)16 (colonic polyps) 6 (diverticulosis) 3 (colorectal cancer). Of the 42 FIT positive patients 16 were on direct oral anticoagulant (DOAC). Patients on DOACs and those on dual anti platelet agents were more likely to be FIT positive. We also found a positive correlation between higher frailty indices, HAS BLED scores and chronic kidney disease and low creatinine clearance r=0.82, p=0.001. Despite the small numbers in this study the correlation is statistically significant Conclusion There is a statistically significant positive correlation of FIT positive and frailty indices with DOACs, Dual anti platelet agents, CKD, low creatinine clearance (r=0.82 and p=0.001). Following this the HASBLED scores increased hence our practices implemented an enhanced surveillance of monitoring these patients quarterly due to the increased risk. We advocate frailty indices should be incorporated in the HAS BLED scores for improved patient safety.

Clinical performance study of a fecal bacterial signature test for colorectal cancer screening.

The fecal immunochemical test (FIT) is the most widely used test for colorectal cancer (CRC) screening. RAID-CRC Screen is a new non-invasive test based on fecal bacterial markers, developed to complement FIT by increasing its specificity. The test was previously clinically evaluated in FIT-positive patients (>20 μg of hemoglobin/g of feces, "FIT20"), in which it reduced the proportion of false positive results by 16.3% while maintaining most of FIT20's sensitivity. The aim of this study was to compare the sensitivity and specificity of a CRC screening program using RAID-CRC Screen in addition to FIT20 as a triage test in a European screening population undergoing screening colonoscopy with a CRC screening program with FIT20 alone in the same cohort. A cohort of 2481 subjects aged > 55 years from the German screening colonoscopy program was included. The colonoscopy findings were used as the gold standard in calculating the diagnostic capacity of the tests and included 15 CRC and 257 advanced neoplasia cases. RAID-CRC Screen added to FIT20 provided the same sensitivity as FIT20 alone (66.7%) in detecting CRC and a significantly higher specificity (97.0% vs. 96.1%, p<0.0001). The positive predictive value was 11.9% when using RAID-CRC Screen and 9.5% with FIT20 alone, and the negative predictive value was 99.8% in the two scenarios. For advanced neoplasia detection, the use of RAID-CRC Screen yielded significantly lower sensitivity than with FIT20 alone (17.5% vs. 21.8%, p = 0.0009), and the overall specificity was significantly higher when using RAID-CRC Screen compared with FIT20 alone (98.2% vs. 97.8%, p = 0.0039). Our findings confirm the results obtained in previous clinical studies in a CRC screening setting, showing the potential of RAID-CRC Screen to increase the overall specificity of FIT-based screening.

Risk factors for colorectal cancer in a fecal immunochemical test-positive group: The National Health Insurance Service-National Health Screening Cohort.

Colorectal cancer (CRC) was the fourth most common cancer in Republic of Korea in 2019. It has a gradually increasing mortality rate, indicating the importance of screening for CRC. Among the various CRC screening test, fecal immunochemical test (FIT) is a simple yet most commonly used. Neverthelss, there have been only few long-term studies on subjects with FIT-positive. Therefore, in this study, we aimed to investigate the risk factors for CRC in FIT-positive patients using the National Health Insurance Service Bigdata database. Among 1737633 individuals with a FIT screening result for CRC in 2009, 101143 (5.82%) were confirmed to be FIT positive. The CRC incidence over 10years (up to 2018) of these participants was investigated using the National Cancer Registry. Out of the 101143 FIT-positive participants, 4395 (4.35%) were diagnosed with CRC. The FIT-positive patients who underwent a second round of screening showed a 5-year cumulative CRC incidence of approximately 1.25%, whereas those who did not showed an incidence of approximately 3.75%. Among the FIT-positive patients, the CRC incidence in the non-compliance group for the second round of screening was 2.8 times higher than that in the compliance group. In FIT-positive participants, non-compliance with the second round of screening was identified as a major risk factor for CRC development. It is necessary to establish appropriate strategies for managing risk factors for CRC in FIT-positive patients to increase the rate of compliance with the second round of CRC screening.

Screening History and 7-Year Survival in 32,099 Colorectal Cancer Patients: A Population-Based Cohort Study.

It is unclear whether colorectal cancer screening history, regardless of stage, is an independent predictor of survival, and if the screening advantage persists after diagnosis. 32 099 patients with colorectal cancer were enrolled in this population-based cohort study. We used data from the Taiwan Cancer Registry on patients with a first-time diagnosis of colorectal cancer between 2013 and 2015. In addition, we utilized data from a nationwide database of colorectal cancer screening programs to evaluate patients' screening histories, and sourced outcome data from the National Death Registry, tracking patients up to the last day of 2019. Compared with fecal immunochemical testing (FIT)-positive patients with a follow-up examination, the adjusted hazard ratios (95% confidence intervals) for death from colorectal cancer were 1.40 (1.26-1.56) for FIT-positive patients without a follow-up examination, 1.63 (1.48-1.78) for FIT-negative patients, and 1.76 (1.65-1.89) for never screened patients. The adjusted hazard ratios for the FIT-positive patients with a follow-up examination increased when diagnosis was delayed by more than 12 months and were 1.2 after a 2-year delay. The adjusted hazard ratios for FIT-negative patients were approximately 2.0, decreased rapidly to 1.6, and stabilized after the 9th time-to-diagnosis month. In colorectal cancer patients, screening history prior to diagnosis is an independent prognostic factor, regardless of cancer stage or other variables. This study recommends that physicians take screening history into account during diagnosis to optimize follow-up and management for patients at higher risk.

Fecal Occult Blood Screening before Cardiac Surgery.

Concerns of gastrointestinal (GI) bleeding after cardiac surgery are increasing with increased use of antiplatelets and anticoagulants. We investigated the roles of preoperative screening for fecal occult blood by fecal immunochemical test (FIT) widely used to detect GI bleeding and cancer. A retrospective review was done in 1,663 consecutive patients undergoing FIT before cardiac surgery between years 2012 and 2020. One or two rounds of FIT were performed 2 to 3 weeks before surgery, when antiplatelets and anticoagulants were not suspended yet. Positive FIT (> 30 μg of hemoglobin/g of feces) was observed in 227 patients (13.7%). Preoperative risk factors for positive FIT included age > 70 years, anticoagulants, and chronic kidney disease. Of those with positive FIT, 180 patients (79%) received preoperative endoscopy, including gastroscopy (n = 139), colonoscopy (n = 9), and both (n = 32), with no findings of bleeding. The most common finding of gastroscopy was atrophic gastritis (36%) while early gastric cancer was detected in 2 patients. The most common finding of colonoscopy was colon polyps (42%) while colorectal cancer was detected in 5 patients. Of 180 FIT-positive patients receiving endoscopy, 8 (4.4%) underwent preoperative GI treatment, while postoperative GI events were documented in 28 (15.6%). Of 1,436 with negative FIT, 21 (1.5%) presented GI complications after surgery. Preoperative FIT, which is influenced by anticoagulant use, has little impacts on identification of GI bleeding sites. However, it may be useful to detect GI malignant lesions, potentially impacting operative risks, surgical strategies, and postoperative management.

The increasing burden of the 2-week wait colorectal cancer pathway in a single centre: the impact of faecal immunochemical tests.

Two-week wait (TWW) volume and colorectal cancer (CRC) detection pose an increasing challenge for NHS cancer services. Primary aims were to assess the introduction of faecal immunochemical tests (FIT) into clinical practice at our centre, the impact on TWW referral volume and CRC diagnoses, and to provide an update to previously published work. A secondary aim was to correlate FIT value and investigation. TWW CRC data following incorporation of FIT into clinical practice were analysed (1 June 2019-31 July 2021). Parameters assessed were monthly referral volume, CRC detection, primary care FIT volume and secondary care investigations. Referrals and CRC detection rates were compared with previously published data (2009-2019). Data relating to primary care FIT were collated from Berkshire and Surrey Pathology Services. TWW referrals increased 360% (2009-2020). CRC incidence decreased from 8.87% to 3.24%. Following incorporation into clinical practice, primary care FIT requests have increased to >450/month and accompanied 1,722/4,796 referrals. CRC incidence is static (3-4%). Patients with FIT <10µg Hb/g faeces undergo radiological imaging more commonly, whereas FIT-positive patients are more likely to undergo endoscopy, although the difference is not statistically significant. No significant change in CRC diagnosis was observed, despite increasing TWW referrals. Increasing utilisation of FIT in both primary and secondary care has helped maintain CRC detection while avoiding diagnostic delay. This study supports growing evidence highlighting the value of FIT in triage, referral and TWW investigation. FIT appears increasingly important for allocating secondary care resources (endoscopy), while guiding primary care referral. Additional low-cost strategies to determine prioritisation or reassurance (e.g. repeat FIT) require further evaluation.

Risk of Proximal Gastrointestinal Cancer After Positive Fecal Immunochemical Test

Fecal immunochemical testing (FIT) is the leading noninvasive colorectal cancer (CRC) screening test worldwide. Many FIT-positive patients have normal colonoscopy, and current guidelines do not support upper gastrointestinal (GI) tract evaluation of these patients.1,2 Because FIT might detect proximal GI bleeding,3 we evaluated the risk of esophageal, gastric, and small bowel cancers in FIT-positive versus FIT-negative patients in a large, multiethnic US cohort.

Colorectal neoplasia prevalence in a predominantly Hispanic community: Results from a colorectal cancer screening program in Texas

BackgroundA community-based, colorectal cancer (CRC) screening program for uninsured/underinsured individuals was successfully implemented in El Paso, Texas to increase CRC screening rates. Our aim was to determine the colorectal neoplasia prevalence among program participants and between screening groups. MethodsWe retrospectively reviewed participant records from 2012 to 2017. Average-risk patients were first screened with a fecal immunochemical test (FIT) and included if positive. Above average-risk patients due to a family history of CRC were referred directly for screening colonoscopy. Patients were excluded if experiencing melena or hematochezia or had a personal history of colon polyps or CRC. ResultsOf the 638 screening colonoscopies performed, 59.4% were in FIT-positive subjects and 40.6% were in subjects with a family history of CRC. Patients were predominantly female (72.9%), aged 50-65 years (84.2%), Hispanic (97.9%), and born in Mexico (92.4%). Overall, the detection rate for polyps, adenomas, and advanced adenomas was 46.2%, 34.3%, and 11.1%, respectively. Fifteen patients had adenocarcinoma (2.4%). Compared with colonoscopies in patients with a family history, FIT-positive patients demonstrated a higher prevalence of polyps (PR 1.39, 95% CI 1.09-1.78), adenomas (PR 1.55, 95% CI 1.15-2.07), advanced adenomas (PR 3.04, 95% CI 1.67-5.56). ConclusionsThis community-based CRC screening program in an enriched cohort of predominantly Mexican Americans was effective in identifying colorectal neoplasia and cancer. Additionally, there was an increased prevalence of colorectal neoplasia in average-risk, FIT-positive patients undergoing screening colonoscopy compared with above average-risk patients with a family history of CRC. Similar screening programs would likely benefit at-risk populations.

A106 THE EPIDEMIOLOGY OF COMPLEX COLONIC POLYPS: A POPULATION BASED STUDY OF THE SOUTHWEST ONTARIO COLONOSCOPY COHORT

BackgroundComplex polyps are well recognized amongst endoscopists, but its definition varies in the literature and from one endoscopist to another. Despite its clinical importance, the epidemiology of complex polyps is poorly understood.AimsTo assess the epidemiology of complex polyps on a population level, and in FIT positive individuals.MethodsThe Southwest Ontario Colonoscopy cohort is a prospective database consisting of all adult patients undergoing colonoscopy at 21 hospitals in Southwest Ontario. Data is collected through a mandatory quality assurance form completed by the endoscopist after each procedure. All outpatient adult colonoscopies for any indication were included. Incomplete colonoscopies, repeat procedures, and poor preparation colonoscopies were excluded. A manual review of the colonoscopy report was completed in cases where the description of the complex polyps was missing. The primary outcomes were the prevalence of complex polyps in the cohort, and in FIT positive patients. Secondary outcomes include endoscopic description of the complex polyp, rates of attempted and complete resection, and identification of possible associations between patient and endoscopist factors with complex polyp detection and removal. A multivariate logistic regression model was generated to assess for factors associated with complex polyp detection.ResultsFrom February 2019 to December 2020, 43389 colonoscopies were included, of which 1459 were for FIT positive patients. 2294 patients had a complex polyp, with a prevalence of 5.3% [95% CI 0.051–0.055], while the prevalence was 17.1% [95% CI 0.152–0.191] in the FIT positive cohort. Compared to average-risk patients undergoing colonoscopy for colon cancer screening, the odds ratio (OR) of detecting a complex polyp in individuals with positive FIT was 4.12 [95% CI 3.42–4.98, p<0.0001]. Among complex polyps,1324 (57.7%) were described as large (>2cm) and 1290 (56%) described as sessile. Of 2294 patients with complex polyps,1992 (86.8%) [95% CI 0.855–0.882] underwent a removal attempt, with successful complete removal as determined by the endoscopist achieved in 1905 patients (95.6%) [95% CI 0.947–0.965]. Compared to gastroenterologists, general surgeons and internists were less likely to detect a complex polyp, OR 0.67 [95% CI 0.61–0.73, p <0.0001] and 0.36 [95% CI 0.20–0.67, p=0.0011] respectively. Trainee involvement was associated with higher rate of complex polyp detection, OR 1.20 [95% CI 1.07–1.35, p=0.0022]. Females were less likely to have a complex polyp compared to males, OR 0.71 [95% CI 0.65–0.77, p<0.0001].ConclusionsComplex polyps are more prevalent than previously reported in the literature, with a high prevalence among the FIT positive population compared to other indications of colonoscopy.Funding AgenciesNone

Timely Colonoscopy After Positive Fecal Immunochemical Tests in the Veterans Health Administration: A Qualitative Assessment of Current Practice and Perceived Barriers.

INTRODUCTION:The Veterans Health Administration introduced a clinical reminder system in 2018 to help address process gaps in colorectal cancer screening, including the diagnostic evaluation of positive fecal immunochemical test (FIT) results. We conducted a qualitative study to explore the differences between facilities who performed in the top vs bottom decile for follow-up colonoscopy.METHODS:Seventeen semistructured interviews with gastroenterology (GI) providers and staff were conducted at 9 high-performing and 8 low-performing sites.RESULTS:We identified 2 domains, current practices and perceived barriers, and most findings were described by both high- and low-performing sites. Findings exclusive to 1 group mainly pertained to current practices, especially arranging colonoscopy for FIT-positive patients. We observed only 1 difference in the perceived barriers domain, which pertained to primary care providers.DISCUSSION:These results suggest that what primarily distinguishes high- and low-performing sites is not a difference in barriers but rather in the GI clinical care process. Developing and disseminating patient education materials about the importance of diagnostic colonoscopy, eliminating in-person precolonoscopy visits when clinically appropriate, and involving GI in missed colonoscopy appointments and outside referrals should all be considered to increase follow-up colonoscopy rates. Our study illustrates the challenges of performing a timely colonoscopy after a positive FIT result and provides insights on improving the clinical care process for patients who are at substantially increased risk for colorectal cancer.

434 Incidence of Normal Colonoscopy in Faecal Immunochemical Test (FIT) Positive Patients in The Colorectal 2-Week-Wait (2WW) Pathway at A District General Hospital (DGH)

IntroductionFIT is a quantitative, highly specific test to detect blood in stool for malignant and non-malignant colorectal diagnoses. Incidence of normal colonoscopy following positive FIT is not widely reported. We conducted a retrospective audit to analyse this patient cohort to evaluate diagnostic accuracy and reporting standards of colonoscopy.MethodFIT-positive was defined as > 10µgHb/g faeces. Using FIT value, patients were separated into Groups 1, 2 and 3: 10-99, 100-200 and >200µgHb/g faeces respectively. Normal colonoscopy was defined as no neoplastic or benign findings reported. Patients referred in the 2WW-pathway after introduction of FIT-testing in October 2019 to the onset of COVID-19 pandemic in March 2020 were included. Data on age, gender, comorbidities and additional investigations were collected.ResultsThere were 1072 referrals in the study period; 405 had FIT done, 265 were FIT-positive and had colonoscopy referral. Four patients were excluded after further investigations showed diverticulosis and gastritis. FIT-stratified normal-colonoscopy rate was 13.3% (28/210) overall, and 14.1% (23/163), 16.7% (2/12) and 8.6% (3/35) for Group 1, 2 and 3 respectively.ConclusionsOur study was limited by the onset of COVID-19 pandemic. In the short study period, 13.3% FIT-positive patients had normal colonoscopy. There are no comparative data in literature for this parameter. Higher FIT-values were associated with lower normal colonoscopy incidence. It is possible that some endoscopists failed to record positive, non-clinically significant findings. We are currently studying larger patient cohorts and in parallel, looking at Bowel Cancer Screening Programme (BCSP) patients.

Predictive Modeling of Colonoscopic Findings in a Fecal Immunochemical Test-Based Colorectal Cancer Screening Program

BackgroundThe fecal immunochemical test (FIT) is the primary modality used by the Los Angeles County Department of Health Services (LADHS) for colorectal cancer (CRC) screening in average-risk patients. Some patients referred for FIT-positive diagnostic colonoscopy have neither adenomas nor more advanced pathology. We aimed to identify predictors of false-positive FIT (FP-FIT) results in our largely disenfranchised, low socioeconomic status population.MethodsWe conducted a retrospective study of 596 patients who underwent diagnostic colonoscopy following a positive screening FIT. Colonoscopies showing adenomas (or more advanced pathology) were considered positive. We employed multiple logistic and linear regression as well as machine learning models (MLMs) to identify clinical predictors of FP-FIT (primary outcome) and the presence of advanced adenomas (secondary outcome).ResultsOverall, 268 patients (45.0%) had a FP-FIT. Female sex and hemorrhoids (odds ratios [ORs] 1.59 and 1.89, respectively) were associated with increased odds of FP-FIT and fewer advanced adenomas (β = − 0.658 and − 0.516, respectively). Conversely, increasing age and BMI (ORs 0.94 and 0.96, respectively) were associated with decreased odds of FP-FIT and a greater number of advanced adenomas (β = 0.073 and 0.041, respectively). MLMs predicted FP-FIT with high specificity (93.8%) and presence of advanced adenoma with high sensitivity (94.4%).ConclusionIncreasing age and BMI are associated with lower odds of FP-FIT and greater number of advanced adenomas, while female sex and hemorrhoids are associated with higher odds of FP-FIT and fewer advanced adenomas. The presence of the aforementioned predictors may inform the decision to proceed with diagnostic colonoscopy in FIT-positive patients.

Serrated Lesion Detection in a Population-based Colon Screening Program.

Serrated lesions give rise to 15% to 30% of all colorectal cancers, driven predominantly by the sessile serrated polyp (SSP). Fecal immunochemical test (FIT), has low sensitivity for SSPs. SSP detection rate (SSPDR) is influenced by performance of both endoscopists and pathologists, as diagnosis can be subtle both on endoscopy and histology. To evaluate the SSPDR in a population-based screening program, and the influence of subspecialty trained pathologists on provincial reporting practices. The colon screening program database was used to identify all FIT-positive patients that received colonoscopy between January 2014 and June 2017. Patient demographics, colonoscopy quality indicators, pathologic diagnoses, and FIT values were collected. This study received IRB approval. A total of 74,605 colonoscopies were included and 26.6% had at least 1 serrated polyp removed. The SSPDR was 7.0%, with 59% of the SSPs detected having a concurrent conventional adenoma. The mean FIT value for colonoscopies with only serrated lesions was less than that for colonoscopies with a conventional adenoma or colorectal cancer (P<0.0001). Centers with a gastrointestinal subspecialty pathologist diagnosed proportionally more SSPs (P<0.0001), and right-sided SSPs than centers without subspecialists. Serrated lesions often occur in conjunction with conventional adenomas and are associated with lower FIT values. Knowledge of the characteristics of SSPs is essential for pathologists to ensure accurate diagnosis of SSPs.

Preference and Experience of Colonic Examination for Participants Presenting to Hospitals with a Positive Fecal Immunochemical Test Result.

PurposePatients who test positive on the fecal immunochemical test (FIT) for colorectal cancer (CRC) are referred for colonoscopy for further diagnostic evaluation. Colonoscopy is not a perfect method and may be a challenge for some FIT-positive patients. Computed tomographic colonography (CTC) is an alternative method that is less invasive and allows examination of the whole colon. The study objective was to evaluate the preference of FIT-positive patients for either colonoscopy or CTC for CRC examination.Patients and MethodsIndividuals older than 40 years with a positive FIT test at eight Japanese hospitals between December 2012 and July 2015 were invited to participate. Participants were given detailed information regarding colonoscopy and CTC before deciding on either examination. They completed questionnaires before the procedure regarding their preference and after the procedure regarding their experience.ResultsThe pre- and post-questionnaires of 846 and 834 participants, respectively, were analyzed. Participants preferred colonoscopy over CTC (colonoscopy, 72%; CTC, 28%). The possibility of obtaining biopsy samples and removing colorectal polyps during the procedure was the main reason for colonoscopy selection. Patients selected CTC to reduce discomfort but reported that CTC bowel preparation was more burdensome than colonoscopy bowel preparation. The overall experience of the examination did not differ between the groups.ConclusionColonoscopy is the standard examination for FIT-positive patients. However, when given a choice, almost one-third of participants chose CTC because they thought it would be a more “comfortable” examination. Clinicians should therefore be aware of patients’ potential preference for noninvasive colorectal examinations.

Linked-color imaging versus white-light colonoscopy in an organized colorectal cancer screening program

Linked-color imaging (LCI), a new image-enhancing technology emphasizing contrast in mucosal color, has been demonstrated to substantially reduce polyp miss rate as compared with standard white-light imaging (WLI) in tandem colonoscopy studies. Whether LCI increases adenoma detection rate (ADR) remains unclear. Consecutive subjects undergoing screening colonoscopy after fecal immunochemical test (FIT) positivity were 1:1 randomized to undergo colonoscopy with LCI or WLI, both in high-definition systems. Insertion and withdrawal phases of each colonoscopy were carried out using the same assigned light. Experienced endoscopists from 7 Italian centers participated in the study. Randomization was stratified by gender, age, and screening round. The primary outcome measure was represented by ADR. Of 704 eligible subjects, 649 were included (48.9% men, mean age ± standard deviation, 60.8 ± 7.3 years) and randomized to LCI (n= 326) or WLI (n= 323) colonoscopy. The ADR was higher in the LCI group (51.8%) than in the WLI group (43.7%) (relative risk, 1.19; 95% confidence interval, 1.01-1.40). The proportions of patients with advanced adenomas and sessile serrated lesions were, respectively, 21.2% and 8.6% in the LCI arm and 18.9% and 5.9% in the WLI arm (not significant for both comparisons). At multivariate analysis, LCI was independently associated with ADR, along with male gender, increasing age, and adequate (Boston Bowel Preparation Scale score≥6) bowel preparation. At per-polyp analysis, the mean ± standard deviation number of adenomas per colonoscopy was comparable in the LCI and WLI arms, whereas the corresponding figures for proximal adenomas was significantly higher in the LCI group (.72 ± 1.2 vs .55 ± 1.07, P= .05) CONCLUSIONS: In FIT-positive patients undergoing screening colonoscopy, the routine use of LCI significantly increased the ADR. (Clinical trial registration number: NCT03690297.).

COVID-19 and Long-term Planning for Procedure-based Specialties During Extended Mitigation and Suppression Strategies

COVID-19 and Long-term Planning for Procedure-based Specialties During Extended Mitigation and Suppression Strategies