Preventive Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Gastrointest Endosc. 2019 May;89(5):1037-1043. doi: 10.1016/j.gie.2019.01.012. Epub 2019 Jan 23.
A fecal immunochemical test (FIT) is often repeated annually, even after a recent colonoscopy. However, there are no published data on the proper approach to FIT-positive patients after a recent colonoscopy. We compared colorectal cancer (CRC) and advanced colorectal neoplasia (ACRN) prevalence based on the interval since the last colonoscopy.
We reviewed asymptomatic screenees aged ≥50 years who underwent FIT and colonoscopy.
Of 2228 FIT-positive participants, 514 had a colonoscopy less than 3 years before (group 1), 427 had a colonoscopy had a colonoscopy 3 to 10 years before (group 2), and 1287 had a colonoscopy >10 years before or no colonoscopy (group 3). The prevalence of CRC in groups 1, 2, and 3 was 2.1%, 1.6%, and 7.2%, respectively, and that for ACRN was 10.9%, 12.6%, and 26.0%, respectively. Even after adjusting for confounders, CRC and ACRN detection rates in group 1 were lower than those in group 3 but not lower than those in group 2. Among 6135 FIT-negative participants, the prevalence of CRC in the 3 groups was .7%, .4%, and 3.4%, respectively, and that for ACRN was 6.0%, 6.1%, and 14.7%, respectively. CRC and ACRN detection rates were significantly higher in FIT-positive participants than in FIT-negative participants in all 3 groups.
In FIT-positive patients who underwent colonoscopy within the prior 3 years, CRC and ACRN prevalence was not low. Our findings support the U.S. Multi-Society Task Force on the CRC screening recommendation that repeat colonoscopy be offered to patients with positive FIT results and recent colonoscopy.
粪便免疫化学检测（FIT）通常每年重复进行，即使在最近的结肠镜检查之后也是如此。然而，目前尚无关于最近结肠镜检查后 FIT 阳性患者的适当处理方法的相关数据。我们比较了基于最近一次结肠镜检查后时间间隔的结直肠癌（CRC）和高级结直肠腺瘤（ACRN）的发生率。
我们回顾了接受 FIT 和结肠镜检查的年龄≥50 岁的无症状筛查者。
在 2228 例 FIT 阳性参与者中，514 例在 3 年以内接受了结肠镜检查（第 1 组），427 例在 3-10 年以前接受了结肠镜检查（第 2 组），1287 例在 10 年以前或从未接受过结肠镜检查（第 3 组）。第 1、2 和 3 组的 CRC 发生率分别为 2.1%、1.6%和 7.2%，ACRN 发生率分别为 10.9%、12.6%和 26.0%。即使在调整了混杂因素后，第 1 组的 CRC 和 ACRN 检出率仍低于第 3 组，但与第 2 组无差异。在 6135 例 FIT 阴性参与者中，3 组的 CRC 发生率分别为 0.7%、0.4%和 3.4%，ACRN 发生率分别为 6.0%、6.1%和 14.7%。在所有 3 组中，FIT 阳性参与者的 CRC 和 ACRN 检出率均明显高于 FIT 阴性参与者。
在最近 3 年内接受过结肠镜检查的 FIT 阳性患者中，CRC 和 ACRN 的发生率并不低。我们的研究结果支持美国多学会 CRC 筛查工作组的建议，即对于 FIT 阳性且最近接受过结肠镜检查的患者，应进行重复结肠镜检查。
