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Colorectal Neoplasia Detection in Individuals With Positive Multitarget Stool DNA Tests: Data From the New Hampshire
Joseph C Anderson1, Christina M Robinson2,3, William M Hisey3
1Geisel School of Medicine at Dartmouth, Hanover.
Journal of Clinical Gastroenterology
|May 11, 2021
Summary
Multitarget stool DNA (mt-sDNA) testing identifies more colorectal cancer (CRC) and advanced neoplasia than colonoscopy alone. Positive mt-sDNA results enrich colonoscopies with significant findings, supporting its clinical utility in community screening.
Area of Science:
- Gastroenterology
- Oncology
- Preventive Medicine
Background:
- The US Preventive Services Task Force (USPSTF) recommends multitarget stool DNA (mt-sDNA) testing for colorectal cancer (CRC) screening in average-risk individuals.
- However, data on colonoscopy outcomes following positive mt-sDNA tests in real-world community settings are limited.
Purpose of the Study:
- To investigate colonoscopy findings and quality in patients with a positive mt-sDNA test compared to those undergoing colonoscopy without prior mt-sDNA testing.
- To assess the clinical utility of mt-sDNA testing in a population-based registry.
Main Methods:
- A comparative study using the New Hampshire Colonoscopy Registry.
- Age-, sex-, and risk-matched patients with positive mt-sDNA tests (N=306) were compared to patients undergoing colonoscopy only (N=918).
- Outcomes included CRC, advanced/non-advanced neoplasia, and normal examinations; quality measures assessed withdrawal time, bowel preparation, and rescreening intervals.
Main Results:
- Patients with positive mt-sDNA tests were significantly more likely to have CRC (1.3% vs. 0.4%) or advanced neoplasia (27.1% vs. 8.2%) (P<0.0001).
- Neoplasia detection rate was 68.0% after positive mt-sDNA versus 42.3% for colonoscopy alone (P<0.0001).
- No significant differences in colonoscopy quality metrics were observed between the groups.
Conclusions:
- Colonoscopy following a positive mt-sDNA test is more frequently associated with CRC and colorectal neoplasia.
- Positive mt-sDNA testing effectively enriches the yield of colonoscopies with clinically relevant findings.
- Findings support the use of mt-sDNA testing in community CRC screening and advise against shortening rescreening intervals for patients with normal colonoscopies after a positive test.
