Klepp Pasquale, Kisiel John B, Småstuen Milada Cvancarova, Røseth Arne, Andersen Solveig N, Vatn Morten H, Ahlquist David A, Moum Bjørn A, Brackmann Stephan
a Department of Internal Medicine, Unger-Vetlesen Institute , Lovisenberg Diaconal Hospital , Oslo , Norway.
b Institute of Clinical Medicine , University of Oslo , Oslo , Norway.
Scand J Gastroenterol. 2018 Mar;53(3):273-278. doi: 10.1080/00365521.2018.1424935. Epub 2018 Jan 9.
Colonoscopic surveillance is recommended in patients with longstanding inflammatory bowel disease (IBD) as they are at increased risk of colorectal cancer (CRC). Non-invasive surveillance may improve compliance and access. Multi-target stool DNA (MT-sDNA) has been validated for screening of sporadic CRC but has not been assessed in IBD. Our aim was to assess the performance of a MT-sDNA test in a real-life surveillance setting of patients with longstanding IBD.
A total of 192 IBD patients enrolled from two prospective cohorts submitted an EDTA buffered stool sample and underwent chromo- or white light colonoscopy. Stools were assayed for methylated BMP3 & NDRG4, mutant KRAS and β-actin by a laboratory blinded to clinical data.
The multitarget-sDNA panel was positive in 2/2 CRC and 5/15 low-grade dysplasia (LGD) < 1 cm in diameter. Sensitivities were 100% (95% CI 16-100%) for CRC and 33% (95% CI 13-61%) for LGD lesions <1 cm, with specificities of 87% (95% CI 81-91%) and 93% (95% CI 88-96%), respectively. The estimated number of patients needed to screen to detect a single CRC was 96 (95% CI 93-99%) and was 28 (95% CI 22-34%) to detect any colorectal neoplasia (CRN).
The MT-sDNA panel detected CRC in IBD. Sensitivity for sub-centimeter colorectal neoplasms in IBD patients appears similar to that observed in the general population. The test may be a valuable tool for detection of malignancy during structured surveillance of long-term IBD in a first line hospital setting.
对于患有长期炎症性肠病（IBD）的患者，推荐进行结肠镜监测，因为他们患结直肠癌（CRC）的风险增加。非侵入性监测可能会提高依从性和可及性。多靶点粪便DNA（MT-sDNA）已被验证可用于散发性CRC的筛查，但尚未在IBD中进行评估。我们的目的是评估MT-sDNA检测在长期IBD患者现实生活监测中的性能。
从两个前瞻性队列中招募了192例IBD患者，他们提交了乙二胺四乙酸（EDTA）缓冲粪便样本并接受了染色或白光结肠镜检查。由对临床数据不知情的实验室对粪便进行甲基化骨形态发生蛋白3（BMP3）和NDRG4、突变型KRAS及β-肌动蛋白的检测。
多靶点-sDNA检测组在2例CRC患者及5例直径<1 cm的低级别发育异常（LGD）患者中呈阳性。对于CRC，敏感性为100%（95%可信区间16%-100%）；对于直径<1 cm的LGD病变，敏感性为33%（95%可信区间13%-61%），特异性分别为87%（95%可信区间81%-91%）和93%（95%可信区间88%-96%）。检测出一例CRC所需筛查的患者估计数量为96例（95%可信区间93%-99%），检测出任何结直肠肿瘤（CRN）所需筛查的患者估计数量为28例（95%可信区间22%-34%）。
MT-sDNA检测组在IBD患者中检测到了CRC。IBD患者中直径小于1厘米的结直肠肿瘤的敏感性似乎与普通人群中观察到的相似。在一线医院环境中，该检测可能是长期IBD结构化监测期间检测恶性肿瘤的有价值工具。
