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Neoplasia Diagnosis After Multi-target Stool DNA Is Enhanced Among Lowest Baseline Detectors
Derek W Ebner1, Kelli N Burger1, Douglas W Mahoney1
1Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Digestive Diseases and Sciences
|July 24, 2023
Summary
Knowing a positive multi-target stool DNA (mt-sDNA) test result before colonoscopy improves neoplasia detection rates, especially for adenomatous and serrated lesions. This enhanced awareness benefits endoscopists with lower baseline detection rates, improving overall colonoscopy quality.
Area of Science:
- Gastroenterology
- Endoscopy
- Cancer Screening
Background:
- Screening colonoscopy effectiveness is limited by variations in colorectal neoplasia detection.
- Individual endoscopist performance metrics are crucial for quality assessment.
Purpose of the Study:
- To evaluate the impact of pre-procedural knowledge of a positive multi-target stool DNA (mt-sDNA) test on colonoscopy quality metrics.
- To quantify changes in neoplasia detection rates among endoscopists based on mt-sDNA results.
Main Methods:
- Retrospective analysis of high-volume endoscopists performing positive mt-sDNA colonoscopies.
- Stratification of endoscopists into quartiles based on baseline adenoma detection rates (ADR).
- Comparison of baseline ADR and sessile serrated lesion (SSL) detection rates with post-mt-sDNA neoplasia diagnosis rates.
Main Results:
- Positive mt-sDNA knowledge significantly increased adenoma detection from 32% to 47% and serrated lesion detection from 13% to 31%.
- Median withdrawal time increased from 10 to 12 minutes, irrespective of baseline detection rates.
- Endoscopists with lower baseline ADR showed disproportionately higher adenoma and serrated neoplasia diagnosis rates after positive mt-sDNA results.
Conclusions:
- Pre-procedural knowledge of a positive mt-sDNA test enhances neoplasia diagnosis compared to average-risk screening.
- The improvement in detection rates was particularly pronounced among endoscopists with lower baseline ADR.
- Awareness of positive mt-sDNA results may increase physician vigilance during colonoscopy, improving quality metrics independently of withdrawal time.
