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Related Experiment Video

Updated: Jan 8, 2026

Evaluation of Colorectal Cancer Risk and Prevalence by Stool DNA Integrity Detection
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Factors Associated with Advanced Adenoma Detection by Colonoscopy After Negative Multitarget Stool DNA Testing.

Ahmed M Ibrahim1, Abdulmalik Saleem2, Muhammad Salman Faisal3

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Digestive Diseases and Sciences
|December 23, 2025
PubMed
Summary
This summary is machine-generated.

Multitarget stool DNA (mt-sDNA) testing for colorectal cancer (CRC) has limitations. Negative results require caution, especially in symptomatic patients, as proximal lesions may be missed, necessitating further colonoscopy when clinically indicated.

Keywords:
CologuardColorectal cancerMultitarget stool DNA testScreening

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Area of Science:

  • Gastroenterology
  • Oncology
  • Diagnostic Medicine

Background:

  • Multitarget stool DNA (mt-sDNA) testing is a non-invasive screening tool for colorectal cancer (CRC).
  • False-negative results from mt-sDNA tests can potentially delay CRC diagnosis.
  • Understanding patient factors associated with advanced lesions after a negative mt-sDNA test is crucial, especially with off-label usage.

Purpose of the Study:

  • To evaluate the negative predictive values (NPVs) of mt-sDNA testing for advanced adenoma (AA) and CRC.
  • To identify patient and procedural characteristics associated with missed advanced lesions after a negative mt-sDNA test.
  • To assess the impact of off-label mt-sDNA use on test performance.

Main Methods:

  • Retrospective study of patients with negative mt-sDNA results who underwent colonoscopy within three years.
  • Calculation of NPVs for advanced adenoma (AA) and colorectal cancer (CRC).
  • Abstraction of patient demographics, colonoscopy indications, polyp characteristics, endoscopist training, prior colonoscopy history, and mt-sDNA usage (original Deep-C Cologuard version).

Main Results:

  • Among 370 patients, 9.2% had advanced precancerous lesions (APL), including 8.4% with AA and 0.8% with CRC.
  • AA detection was associated with a higher polyp count, larger polyp size, and proximal location (hepatic flexure, transverse colon).
  • Gastrointestinal bleeding was more frequent in patients with AA (32.3% vs. 14.2%). Experienced endoscopists detected all AAs and CRCs.

Conclusions:

  • Conditional NPVs for AA and CRC after negative mt-sDNA testing were 91.6% and 99.2%, respectively.
  • Proximal lesions were more frequently missed, emphasizing the need for thorough colonoscopic examination.
  • Negative mt-sDNA results warrant cautious interpretation, particularly in symptomatic individuals, with colonoscopy recommended when clinically indicated.