Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.
Clin Transl Gastroenterol. 2021 Jun 18;12(6):e00375. doi: 10.14309/ctg.0000000000000375.
Significant variability between colonoscopy operators contributes to postcolonoscopy colorectal cancers (CRCs). We aimed to estimate postcolonoscopy colorectal neoplasia (CRN) detection by multi-target stool DNA (mt-sDNA), which has not previously been studied for this purpose.
In a retrospective cohort of patients with +mt-sDNA and completed follow-up colonoscopy, positive predictive value (PPV) for endpoints of any CRN, advanced adenoma, right-sided neoplasia, sessile serrated polyps (SSP), and CRC were stratified by the time since previous colonoscopy (0-9, 10, and ≥11 years). mt-sDNA PPV at ≤9 years from previous average-risk screening colonoscopy was used to estimate CRN missed at previous screening colonoscopy.
Among the 850 studied patients with +mt-sDNA after a previous negative screening colonoscopy, any CRN was found in 535 (PPV 63%). Among 107 average-risk patients having +mt-sDNA ≤9 years after last negative colonoscopy, any CRN was found in 67 (PPV 63%), advanced neoplasia in 16 (PPV 15%), right-sided CRN in 48 (PPV 46%), and SSP in 20 (PPV 19%). These rates were similar to those in 47 additional average risk persons with previous incomplete colonoscopy and in an additional 68 persons at increased CRC risk. One CRC (stage I) was found in an average risk patient who was mt-sDNA positive 6 years after negative screening colonoscopy.
The high PPV of mt-sDNA 0-9 years after a negative screening colonoscopy suggests that lesions were likely missed on previous examination or may have arisen de novo. mt-sDNA as an interval test after negative screening colonoscopy warrants further study.
结肠镜检查医生之间存在显著差异，这导致了结直肠癌（CRC）的发生。我们旨在评估多靶点粪便 DNA（mt-sDNA）检测在结直肠腺瘤（CRN）中的应用，因为目前尚未针对该目的进行相关研究。
在一项前瞻性队列研究中，我们对具有阳性 mt-sDNA 结果且完成随访结肠镜检查的患者进行了分析。根据距上次结肠镜检查的时间（0-9 年、10 年和≥11 年），对任何 CRN、高级别腺瘤、右半结肠肿瘤、无蒂锯齿状息肉（SSP）和 CRC 的阳性预测值（PPV）进行分层。使用距上次平均风险筛查结肠镜检查≤9 年的 mt-sDNA 的 PPV 来估计在上次筛查结肠镜检查中遗漏的 CRN。
在 850 例经上一次阴性筛查性结肠镜检查后出现阳性 mt-sDNA 的患者中，535 例（PPV63%）发现了任何 CRN。在 107 例上次阴性结肠镜检查后≤9 年且具有平均风险的患者中，67 例（PPV63%）发现了任何 CRN，16 例（PPV15%）发现了高级别腺瘤，48 例（PPV46%）发现了右半结肠肿瘤，20 例（PPV19%）发现了 SSP。这些发生率与另外 47 例具有不完全结肠镜检查史和 68 例 CRC 风险增加的平均风险患者相似。一名平均风险患者在阴性筛查性结肠镜检查后 6 年出现 mt-sDNA 阳性，发现了 1 例 CRC（I 期）。
阴性筛查性结肠镜检查后 0-9 年 mt-sDNA 的高 PPV 表明，之前的检查可能遗漏了病变，或者可能是新出现的病变。mt-sDNA 作为阴性筛查性结肠镜检查后的间隔试验，值得进一步研究。
