Risk stratification for advanced colorectal neoplasia according to fecal hemoglobin concentration in a colorectal...

Area of Science:

• Gastroenterology
• Oncology
• Preventive Medicine

Background:

• Quantitative fecal immunochemical tests (FIT) enable precise hemoglobin measurement in stool.
• Optimal cut-off concentrations can be selected for FIT results.
• Identifying individuals at highest risk for advanced colorectal neoplasia is crucial for effective screening.

Purpose of the Study:

• To investigate if quantitative FIT results, along with other factors, can identify individuals at greatest risk for advanced colorectal neoplasia.
• To stratify risk for advanced colorectal neoplasia based on FIT results, age, and sex.

Main Methods:

• Retrospective analysis of 3109 participants with positive FIT results (≥20 μg/g) from a colorectal cancer screening program.
• Colonoscopy was performed on all participants.
• Participants were categorized based on the presence of advanced colorectal neoplasia or nonadvanced colorectal neoplasia.

Main Results:

• Median fecal hemoglobin concentrations were significantly higher in participants with advanced colorectal neoplasia (105 μg/g) versus nonadvanced (47 μg/g).
• Sex, age (60-69 years), and fecal hemoglobin concentration (>177 μg/g) were independent predictors of advanced colorectal neoplasia.
• A risk stratification model identified 16 categories, with risk increasing 11.46-fold from the lowest to highest category (positive predictive values 21.3%–75.6%).

Conclusions:

• Fecal hemoglobin concentration, sex, and age effectively stratify the probability of detecting advanced colorectal neoplasia in individuals with positive FIT results.
• These factors should guide the prioritization of individuals for colonoscopy examinations.