Serrated Polyp Yield at Colonoscopy in Patients with Positive FIT, Positive mt-sDNA, and Colonoscopy Only: Data from the New Hampshire Colonoscopy Registry

Author:

Anderson Joseph C.12ORCID,Hisey William M.34ORCID,Robinson Christina M.34ORCID,Limburg Paul J.56ORCID,Kneedler Bonny L.6ORCID,Butterly Lynn F.134ORCID

Affiliation:

1. 1Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.

2. 2White River Junction VAMC, WRJ, Vermont.

3. 3Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

4. 4NH Colonoscopy Registry, Lebanon, New Hampshire.

5. 5Mayo Clinic, Rochester, Minnesota.

6. 6Exact Sciences Corporation, Madison, Wisconsin.

Abstract

Abstract Background: Stool-based screening with fecal immunochemical (FIT) or multitarget-stool DNA (mt-sDNA) tests is associated with increased colonoscopy polyp yield. mt-sDNA includes methylated markers, which improve detection of serrated polyps (SP) versus FIT. We compared SP detection in colonoscopies performed for positive FIT or mt-sDNA tests, as well as in colonoscopies without a preceding stool test, using the New Hampshire Colonoscopy Registry, a comprehensive statewide population-based registry. Methods: Across the three groups, we compared the frequency of clinically relevant SPs (CRSP: sessile SPs, hyperplastic polyps ≥10 mm, and traditional serrated adenomas). We also compared SP size, histology, number, and bulk (combined sizes). Results: Our sample included 560 mt-sDNA+ (age ± SD: 66.5 ± 7.9), 414 FIT+ (age ± SD: 66.3 ± 8.8), and 59,438 colonoscopy-only patients (age ± SD: 61.7 ± 8.0). mt-sDNA+ patients were more likely to have a higher yield of CRSPs and CRSP bulk than FIT+ (P < 0.0001) or colonoscopy-only patients (P < 0.0001). More mt-sDNA+ patients had CRSPs without large adenomas or colorectal cancers (17.9% vs. 9.9% of FIT+ and 8% of colonoscopy-only patients). After adjusting for synchronous large adenomas, colorectal cancers, and other risk factors, mt-sDNA+ patients were more likely (OR, 1.82; 95% CI, 1.18–2.85) than FIT+ patients to have CRSPs. Conclusions: mt-sDNA+ patients had a higher SP yield than FIT+ or colonoscopy-only patients, particularly in the absence of synchronous large adenomas or colorectal cancer. Impact: Our results suggest that screening with mt-sDNA tests could improve colorectal cancer screening by identifying more patients at increased risk from the serrated pathway.

Funder

Audrey and Theodor Geisel School of Medicine at Dartmouth

Publisher

American Association for Cancer Research (AACR)

Subject

Oncology,Epidemiology

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