Department of Gastroenterology & Hepatology, Department of Medicine, University of Utah Health, Salt Lake City, Utah, USA.
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Gastrointest Endosc. 2022 Aug;96(2):208-222.e14. doi: 10.1016/j.gie.2022.04.004. Epub 2022 Apr 9.
Current adenoma detection rate (ADR) benchmarks for colonoscopy in individuals positive for a fecal immunochemical test (FIT) are ≥45% in men and ≥35% in women. These are based on weak, low-quality evidence. We performed a meta-analysis to ascertain the pooled ADR in FIT-positive colonoscopy.
Major databases like PubMed, EMBASE, and Web of Science were searched in October 2021 for studies reporting on ADR of colonoscopy in a FIT-positive population. Meta-analysis was performed by standard methodology using the random-effects model. Heterogeneity was assessed by I and 95% prediction interval statistics.
Thirty-four high-quality studies that included more than 6 million asymptomatic average-risk individuals were analyzed; 2,655,345 individuals completed a screening FIT test. The pooled FIT screening rate was 69.8% (95% CI, 62.8-76.1), the pooled FIT positivity rate was 5.4% (95% CI, 4.3-6.9), and the colonoscopy completion rate was 85% (95% CI, 82.8-86.9). The pooled ADR was 47.8% (95% CI, 44.1-51.6), pooled advanced ADR was 25.3% (95% CI, 22-29), and the pooled colorectal cancer detection rate was 5.1% (95% CI, 4.4-5.9). The pooled ADR in men was 58.3% (95% CI, 52.8-63.6) and in women was 41.9% (95% CI, 36.4-47.6). The pooled ADR with qualitative FIT assessment was 67.7% (95% CI, 50.7-81), with 1-stool sample FIT was 52.8% (95% CI, 48.8-56.8), and at a cutoff threshold of 100 ng hemoglobin/mL was 52.1% (95% CI, 47-57.1). Based on time-period cumulative analysis, the ADR improved over time from 30.5% (95% CI, 24.6-37.2) to 47.8% (95% CI, 44.1-51.6).
This meta-analysis supports the current ADR benchmarks for colonoscopy in FIT-positive individuals. Excellent pooled ADR parameters were demonstrated with qualitative assessment of 1 stool sample at a test cutoff value of 100 ng hemoglobin/mL, and ADR per endoscopist improved over time.
目前，粪便免疫化学检测（FIT）阳性人群行结肠镜检查的腺瘤检出率（ADR）基准为男性≥45%，女性≥35%。这些基准是基于弱、低质量证据制定的。我们进行了一项荟萃分析，以确定 FIT 阳性结肠镜检查的汇总 ADR。
2021 年 10 月，我们在 PubMed、EMBASE 和 Web of Science 等主要数据库中检索了报告 FIT 阳性人群中结肠镜检查 ADR 的研究。采用随机效应模型的标准方法进行荟萃分析。使用 I 检验和 95%预测区间统计量评估异质性。
分析了 34 项高质量研究，这些研究纳入了超过 600 万例无症状一般风险个体；265.5345 例个体完成了筛查性 FIT 检测。汇总的 FIT 筛查率为 69.8%（95%CI，62.8-76.1），FIT 阳性率为 5.4%（95%CI，4.3-6.9），结肠镜检查完成率为 85%（95%CI，82.8-86.9）。汇总的 ADR 为 47.8%（95%CI，44.1-51.6），汇总的高级 ADR 为 25.3%（95%CI，22-29），结直肠癌检出率为 5.1%（95%CI，4.4-5.9）。男性的 ADR 为 58.3%（95%CI，52.8-63.6），女性为 41.9%（95%CI，36.4-47.6）。采用定性 FIT 评估的 ADR 为 67.7%（95%CI，50.7-81），单份粪便样本 FIT 为 52.8%（95%CI，48.8-56.8），以 100ng 血红蛋白/ml 为检测截止值时为 52.1%（95%CI，47-57.1）。基于时间周期累积分析，ADR 随时间推移而改善，从 30.5%（95%CI，24.6-37.2）提高至 47.8%（95%CI，44.1-51.6）。
本荟萃分析支持目前 FIT 阳性人群行结肠镜检查的 ADR 基准。采用定性评估 1 份粪便样本且检测截止值为 100ng 血红蛋白/ml 时，可获得出色的汇总 ADR 参数，并且随着时间推移，每位内镜医生的 ADR 均有所提高。
