Sessile serrated polyp detection rates after fecal immunochemical test or multitarget stool DNA test: Systematic review and meta-analysis

 

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Abstract

Background and study aims Published studies report a higher adenoma detection rate (ADR) for FIT-DNA as compared with FIT. Data are less replete about the performance of stool-based tests for sessile serrated polyp (SSP) detection. We performed a meta-analysis to evaluate the performance of FIT and FIT-DNA testing for SSP detection rate (SSPDR) in patients undergoing colonoscopy for follow up of positive noninvasive tests.

Methods A comprehensive literature search of multiple databases (until September 2022) was performed to identify studies reporting SSPDR in patients with positive FIT or FIT-DNA tests. The outcome was overall colonoscopy detection of any SSPs and advanced serrated polyps (ASP: SSP ≥ 10 mm and/or dysplasia).

Results Included were 482,405 patients (52.4% females) with a mean age of 62.3 ± 4.4 years from 23 studies. The pooled SSPDR for all positive stool-based tests was 5.3% and higher for FIT-DNA (15.0%, 95% confidence interval [CI] 8.3–25.7) versus FIT (4.1%, 95% CI 3.0–5.6; P = 0.0002). The overall pooled ASP detection rate was 1.4% (95% CI 0.81–2.3) and higher for FIT-DNA (3.8 %, 95% CI 1.7–8.6) compared with FIT (0.71%, 95% CI 0.36–1.4; P<0.01). SSPDR with FIT-DNA was also significantly higher than FIT when the FIT cutoff was >10 ug/g and in FIT-positive patients in studies conducted in North America (P<0.05).

Conclusions FIT-DNA outperformed FIT in both SSP and ASP detection including FIT with a lower threshold cutoff of >10 ug/g. Further comparative studies are needed to assess the impact of our findings on colorectal cancer reduction.

Publication History

Received: 10 August 2023

Accepted after revision: 23 January 2024

Accepted Manuscript online:
29 January 2024

Article published online:
05 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
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• References

• 1 Shaukat A, Kahi CJ, Burke CA. et al. ACG Clinical Guidelines: Colorectal Cancer Screening 2021. Am J Gastroenterol 2021; 116: 458-479 DOI: 10.14309/ajg.0000000000001122. (PMID: 33657038)
  CrossrefPubMedGoogle Scholar
• 2 Rex DK, Boland CR, Dominitz JA. et al. Colorectal cancer screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2017; 86: 18-33
  CrossrefPubMedGoogle Scholar
• 3 Lin JS, Piper MA, Perdue LA. et al. Screening for colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2016; 315: 2576-2594 DOI: 10.1001/jama.2016.3332. (PMID: 27305422)
  CrossrefPubMedGoogle Scholar
• 4 Imperiale TF, Ransohoff DF, Itzkowitz SH. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med 2014; 371: 187-188 DOI: 10.1056/NEJMoa1311194. (PMID: 24645800)
  CrossrefPubMedGoogle Scholar
• 5 Jensen CD, Corley DA, Quinn VP. et al. Fecal immunochemical test program performance over 4 rounds of annual screening: a retrospective cohort study. Ann Intern Med 2016; 164: 456-463 DOI: 10.7326/M15-0983. (PMID: 26811150)
  CrossrefPubMedGoogle Scholar
• 6 Rex DK, Ahnen DJ, Baron JA. et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol 2012; 107: 1315-1329
  CrossrefPubMedGoogle Scholar
• 7 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: The prisma statement. Ann Intern Med 2009; 151: 264-269 DOI: 10.1371/journal.pmed.1000097. (PMID: 19621072)
  CrossrefPubMedGoogle Scholar
• 8 Stroup DF, Berlin JA, Morton SC. et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283: 2008-2012 DOI: 10.1001/jama.283.15.2008. (PMID: 10789670)
  CrossrefPubMedGoogle Scholar
• 9 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Europ J Epidemiol 2010; 25: 603-605 DOI: 10.1007/s10654-010-9491-z. (PMID: 20652370)
  CrossrefPubMedGoogle Scholar
• 10 Jadad AR, Moore RA, Carroll D. et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials 1996; 17: 1-12 DOI: 10.1016/0197-2456(95)00134-4. (PMID: 8721797)
  CrossrefPubMedGoogle Scholar
• 11 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188 DOI: 10.1016/0197-2456(86)90046-2. (PMID: 3802833)
  CrossrefPubMedGoogle Scholar
• 12 Sutton AJ, Abrams KR, Jones DR. et al. Methods for meta-analysis in medical research. John Wiley & Sons Ltd; 2000
  Google Scholar
• 13 Kanwal F, White D. "Systematic reviews and meta-analyses" in Clinical Gastroenterology and Hepatology. Clin Gastroenterol Hepatol 2012; 10: 1184-1186 DOI: 10.1016/j.cgh.2012.09.019. (PMID: 23000489)
  CrossrefPubMedGoogle Scholar
• 14 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557 DOI: 10.1136/bmj.327.7414.557. (PMID: 12958120)
  CrossrefPubMedGoogle Scholar
• 15 Guyatt GH, Oxman AD, Kunz R. et al. GRADE guidelines: 7. Rating the quality of evidence -- inconsistency. J Clin Epidemiol 2011; 64: 1294-1302 DOI: 10.1016/j.jclinepi.2011.03.017. (PMID: 21803546)
  CrossrefPubMedGoogle Scholar
• 16 Easterbrook PJ, Gopalan R, Berlin JA. et al. Publication bias in clinical research. Lancet 1991; 337: 867-872 DOI: 10.1016/0140-6736(91)90201-y. (PMID: 1672966)
  CrossrefPubMedGoogle Scholar
• 17 Duval S, Tweedie R. Trim and fill: A simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000; 56: 455-463 DOI: 10.1111/j.0006-341x.2000.00455.x. (PMID: 10877304)
  CrossrefPubMedGoogle Scholar
• 18 Rothstein HR, Sutton AJ, Borenstein M. Publication bias in meta-analysis: Prevention, assessment and adjustments. John Wiley & Sons; 2006
  Google Scholar
• 19 Bleijenberg AGC, van Leerdam ME, Bargeman M. et al. Substantial and sustained improvement of serrated polyp detection after a simple educational intervention: results from a prospective controlled trial. Gut 2020; 69: 2150-2158
  CrossrefPubMedGoogle Scholar
• 20 Bronzwaer MES, Vleugels JLA, Van Doorn SC. et al. Are adenoma and serrated polyp detection rates correlated with endoscopists' sensitivity of optical diagnosis?. Endoscopy 2020; 52: 763-772
  Article in Thieme ConnectPubMedGoogle Scholar
• 21 Carot L, Castells A, Hernandez C. et al. Detection of serrated lesions in proximal colon by simulated sigmoidoscopy vs faecal immunochemical testing in a multicentre, pragmatic, randomised controlled trial. United European Gastroenterol J 2018; 6: 1527-1537 DOI: 10.1177/2050640618804722. (PMID: 30574323)
  CrossrefPubMedGoogle Scholar
• 22 Chang LC, Shun CT, Hsu WF. et al. Fecal immunochemical test detects sessile serrated adenomas and polyps with a low level of sensitivity. Clin Gastroenterol Hepatol 2017; 15: 872-879.e871
  CrossrefPubMedGoogle Scholar
• 23 Chu JE, Hamm J, Gentile L. et al. Serrated lesion detection in a population-based colon screening program. J Clin Gastroenterol 2022; 56: 243-248 DOI: 10.1097/MCG.0000000000001519. (PMID: 33780220)
  CrossrefPubMedGoogle Scholar
• 24 Cock C, Anwar S, Byrne SE. et al. Low sensitivity of fecal immunochemical tests and blood-based markers of DNA hypermethylation for detection of sessile serrated adenomas/polyps. Digest Dis Sci 2019; 64: 2555-2562 DOI: 10.1007/s10620-019-05569-8. (PMID: 30835026)
  CrossrefPubMedGoogle Scholar
• 25 Del Carmen Manzano-Robleda M, Espinosa-Tamez P, Potter MB. et al. Fecal immunologic test results and diagnostic colonoscopy in a Mexican population at average risk for colorectal cancer. Cancer Prev Res 2020; 13: 959-965
  CrossrefPubMedGoogle Scholar
• 26 Denis B, Gendre I. Colonoscopy may be weak link in organised colorectal cancer screening programme with faecal immunochemical test. Journal of medical screening 2022; 29: 84-91 DOI: 10.1177/09691413211061118. (PMID: 34866481)
  CrossrefPubMedGoogle Scholar
• 27 Grobbee EJ, Vlugt M van der, van Vuuren AJ. et al. Diagnostic yield of one-time colonoscopy vs one-time flexible sigmoidoscopy vs multiple rounds of mailed fecal immunohistochemical tests in colorectal cancer screening. Clin Gastroenterol Hepatol 2020; 18: 667-675.e661
  CrossrefPubMedGoogle Scholar
• 28 Kligman E, Li W, Eckert GJ. et al. Adenoma detection rate in asymptomatic patients with positive fecal immunochemical tests. Dig Dis Sci 2018; 63: 1167-1172
  CrossrefPubMedGoogle Scholar
• 29 Lund M, Erichsen R, Valori R. et al. Data quality and colonoscopy performance indicators in the prevalent round of a FIT-based colorectal cancer screening program. Scandinavian J Gastroenterol 2019; 54: 471-477 DOI: 10.1080/00365521.2019.1597158. (PMID: 30978128)
  CrossrefPubMedGoogle Scholar
• 30 Mowat C, Digby J, Strachan JA. et al. Low sensitivity of fecal immunochemical tests (FIT) for detection of sessile serrated adenomas/polyps confirmed over clinical setting, geography, and FIT system. Dig Dis Sci 2019; 64: 3024-3026 DOI: 10.1007/s10620-019-05661-z. (PMID: 31104198)
  CrossrefPubMedGoogle Scholar
• 31 O'Reilly SM, MacNally S, O'Donoghue D. et al. Correlation of fecal immunochemical testing levels with pathology results in a national colorectal cancer screening program. Clin Transl Gastroenterol 2021; 12: e00277
  CrossrefPubMedGoogle Scholar
• 32 Telford J, Gondara L, Pi S. et al. Higher adenoma detection, sessile serrated lesion detection and proximal sessile serrated lesion detection are associated with physician specialty and performance on direct observation of procedural skills. BMJ Open Gastroenterol 2021; 8: e000677
  CrossrefPubMedGoogle Scholar
• 33 Van Doorn SC, Stegeman I, Stroobants AK. et al. Fecal immunochemical testing results and characteristics of colonic lesions. Endoscopy 2015; 47: 1011-1017 DOI: 10.1055/s-0034-1392412. (PMID: 26126163)
  Article in Thieme ConnectPubMedGoogle Scholar
• 34 Zorzi M, Senore C, Da Re F. et al. Detection rate and predictive factors of sessile serrated polyps in an organised colorectal cancer screening programme with immunochemical faecal occult blood test: The EQuIPE study (Evaluating Quality Indicators of the Performance of Endoscopy). Gut 2017; 66: 1233-1240
  CrossrefPubMedGoogle Scholar
• 35 Anderson JC, Robinson CM, Hisey W. et al. Colonoscopy findings in FIT+ and mt-sDNA+ patients versus in colonoscopy-only patients: New Hampshire Colonoscopy Registry data. Cancer Prev Res 2022; 15: 455-464 DOI: 10.1158/1940-6207.CAPR-21-0581. (PMID: 35378546)
  CrossrefPubMedGoogle Scholar
• 36 Bosch LJW, Melotte V, Mongera S. et al. Multitarget stool DNA test performance in an average-risk colorectal cancer screening population. Am J Gastroenterol 2019; 114: 1909-1918 DOI: 10.14309/ajg.0000000000000445. (PMID: 31764091)
  CrossrefPubMedGoogle Scholar
• 37 Imperiale TF, Ransohoff DF, Itzkowitz SH. et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med 2014; 370: 1287-1297 DOI: 10.1056/NEJMoa1311194. (PMID: 24645800)
  CrossrefPubMedGoogle Scholar
• 38 Deiss-Yehiely N, Graffy PM, Weigman B. et al. Detection of high-risk sessile serrated lesions: multitarget stool DNA Versus CT colonography. Am J Roentgenol 2022; 218: 670-676 DOI: 10.2214/AJR.21.26719. (PMID: 34755523)
  CrossrefPubMedGoogle Scholar
• 39 Imperiale TF, Kisiel JB, Itzkowitz SH. et al. Specificity of the multi-target stool DNA test for colorectal cancer screening in average-risk 45–49 year-olds: a cross-sectional study. Cancer Prev Res 2021; 14: 489-496 DOI: 10.1158/1940-6207.CAPR-20-0294. (PMID: 33436397)
  CrossrefPubMedGoogle Scholar
• 40 Johnson DH, Kisiel JB, Burger KN. et al. Multitarget stool DNA test: clinical performance and impact on yield and quality of colonoscopy for colorectal cancer screening. Gastrointest Endosc 2017; 85: 657-665.e651
  CrossrefPubMedGoogle Scholar
• 41 Vakil N, Ciezki K, Huq N. et al. Multitarget stool DNA testing for the prevention of colon cancer: outcomes in a large integrated healthcare system. Gastrointest Endosc 2020; 92: 334-341 DOI: 10.1016/j.gie.2019.12.027. (PMID: 31904379)
  CrossrefPubMedGoogle Scholar
• 42 Butterly L, Robinson CM, Anderson JC. et al. Serrated and adenomatous polyp detection increases with longer withdrawal time: results from the New Hampshire Colonoscopy Registry. Am J Gastroenterol 2014; 109: 417-426
  CrossrefPubMedGoogle Scholar
• 43 Shaukat A, Tuskey A, Rao VL. et al. Interventions to improve adenoma detection rates for colonoscopy. Gastrointest Endosc 2022; 96: 171-183 DOI: 10.1016/j.gie.2022.03.026. (PMID: 35680469)
  CrossrefPubMedGoogle Scholar
• 44 Keswani RN, Crockett SD, Calderwood AH. AGA Clinical Practice Update on Strategies to Improve Quality of Screening and Surveillance Colonoscopy: Expert Review. Gastroenterology 2021; 161: 701-711 DOI: 10.1053/j.gastro.2021.05.041. (PMID: 34334168)
  CrossrefPubMedGoogle Scholar
• 45 Anderson JC, Hisey W, Mackenzie TA. et al. Clinically significant serrated polyp detection rates and risk for postcolonoscopy colorectal cancer: data from the New Hampshire Colonoscopy Registry. Gastrointest Endosc 2022; 96: 310-317
  CrossrefPubMedGoogle Scholar
• 46 Imperiale TF, Ransohoff DF, Itzkowitz SH. et al. Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population. N Engl J Med 2004; 351: 2704-2714 DOI: 10.1056/NEJMoa033403. (PMID: 15616205)
  CrossrefPubMedGoogle Scholar
• 47 Anderson JC, Robertson DJ. Serrated Polyp detection by the fecal immunochemical test: an imperfect FIT. Clin Gastroenterol Hepatol 2017; 15: 880-882 DOI: 10.1016/j.cgh.2016.11.014. (PMID: 27847280)
  CrossrefPubMedGoogle Scholar
• 48 Knudsen AB, Rutter CM, Peterse EFP. et al. Colorectal Cancer Screening: An Updated Decision Analysis for the US Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US); 2021 May. Report No.: 20–05271-ER2.
  PubMedGoogle Scholar
• 49 Itzkowitz SH, Ahlquist DA. The Case for a multitarget stool DNA test: A closer look at the cost effectiveness model. Gastroenterology 2017; 152: 1620-1621 DOI: 10.1053/j.gastro.2016.11.058. (PMID: 28384447)
  CrossrefPubMedGoogle Scholar
• 50 Ladabaum U, Mannalithara A. Comparative effectiveness and cost effectiveness of a multitarget stool DNA test to screen for colorectal neoplasia. Gastroenterology 2016; 151: 427-439 e426 DOI: 10.1053/j.gastro.2016.06.003. (PMID: 27311556)
  CrossrefPubMedGoogle Scholar
• 51 Redwood DG, Dinh TA, Kisiel JB. et al. Cost-effectiveness of multitarget stool DNA testing vs colonoscopy or fecal immunochemical testing for colorectal cancer screening in Alaska Native people. Mayo Clin Proc 2021; 96: 1203-1217 DOI: 10.1016/j.mayocp.2020.07.035. (PMID: 33840520)
  CrossrefPubMedGoogle Scholar
• 52 Sharma T. Analysis of the effectiveness of two noninvasive fecal tests used to screen for colorectal cancer in average-risk adults. Public Health 2020; 182: 70-76 DOI: 10.1016/j.puhe.2020.01.021. (PMID: 32179290)
  CrossrefPubMedGoogle Scholar
• 53 Lee JK, Liles EG, Bent S. et al. Accuracy of fecal immunochemical tests for colorectal cancer: systematic review and meta-analysis. Ann Intern Med 2014; 160: 171 DOI: 10.7326/M13-1484. (PMID: 24658694)
  CrossrefPubMedGoogle Scholar
• 54 Imperiale TF. Quantitative immunochemical fecal occult blood tests: is it time to go back to the future?. Ann Intern Med 2007; 146: 309-311 DOI: 10.7326/0003-4819-146-4-200702200-00013. (PMID: 17310056)
  CrossrefPubMedGoogle Scholar
• 55 Wieten E, Schreuders EH, Nieuwenburg SA. et al. Effects of increasing screening age and fecal hemoglobin cutoff concentrations in a colorectal cancer screening program. Clin Gastroenterol Hepatol 2016; 14: 1771-1777 DOI: 10.1016/j.cgh.2016.08.016. (PMID: 27567693)
  CrossrefPubMedGoogle Scholar
• 56 Burke CA, Lieberman D, Feuerstein JD. AGA Clinical Practice Update on Approach to the Use of Noninvasive Colorectal Cancer Screening Options: Commentary. Gastroenterology 2022; 162: 952-956 DOI: 10.1053/j.gastro.2021.09.075. (PMID: 35094786)
  CrossrefPubMedGoogle Scholar
• 57 Macaron C, Rouphael C, Burke CA. Setting a benchmark for serrated polyp detection rate: defining the target and terminology comes first. Gastrointest Endosc 2022; 96: 318-320 DOI: 10.1016/j.gie.2022.04.022. (PMID: 35715237)
  CrossrefPubMedGoogle Scholar
• 58 Vennelaganti S, Cuatrecasas M, Vennalaganti P. et al. Interobserver agreement among pathologists in the differentiation of sessile serrated from hyperplastic polyps. Gastroenterology 2021; 160: 452-454 e451
  CrossrefPubMedGoogle Scholar

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