Butterly Lynn F, Hisey William M, Robinson Christina M, Limburg Paul J, Kneedler Bonny L, Anderson Joseph C
Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
Prev Med Rep. 2023 Jul 3;35:102309. doi: 10.1016/j.pmedr.2023.102309. eCollection 2023 Oct.
We utilized the population-based New Hampshire Colonoscopy Registry to calculate false discovery rates (FDR) and positive predictive values (PPVs) using three 'positive' colonoscopy definitions. Understanding the frequency of meaningful 'true positive' mt-sDNA and Fecal Immunochemical Test (FIT) results can optimize the use of these colorectal cancer (CRC) screening tests. We calculated FDR (positive stool test followed by negative colonoscopy divided by all positive stool tests) and PPV for mt-sDNA and FIT cohorts using the following definitions: 1) DeeP-C Study (CRC, adenomas/serrated polyps ≥ 1 cm, villous/High Grade Dysplasia); 2) < 10 year US Multi-Society Task Force (USMSTF) follow-up: DeeP-C findings & ≥1 sessile serrated polyps (SSPs) < 1 cm (with/without dysplasia) or ≥ 1 tubular adenomas < 1 cm. 3) Clinically Significant: DeeP-C + USMSTF + clinically significant serrated polyps: traditional serrated adenomas, SSPs, hyperplastic polyps (HPs) > 1 cm, and 5-9 mm proximal HPs. The sample included 549 mt-sDNA + and 410 FIT + and patients (mean age 66.4, 43.0% male). Using the most limited definition of positive colonoscopy, DeeP-C, FDR was 71.9% for mt-sDNA + and 81.7% for FIT +. Using the USMSTF definition, FDR decreased substantially: mt-sDNA+:33.2% and FIT+:47.6%. Adding all CSSPs resulted in the lowest FDR: mt-sDNA+:32.2% and FIT+:47.1%. Decreasing FDRs corresponded to increasing PPVs: mt-sDNA+:28.1% and FIT+:18.3% (DeeP-C definition) and mt-sDNA+:67.8% and FIT+:52.9% (DeeP-C + USMSTF + CSSP) (Table 1). FDRs decreased substantially when the definition of positive exams included all significant precancerous findings. These data present a comprehensive understanding of false positive outcomes at colonoscopies following positive stool tests, which to our knowledge is the first such analysis.
我们利用基于人群的新罕布什尔结肠镜检查登记处，使用三种“阳性”结肠镜检查定义来计算假发现率（FDR）和阳性预测值（PPV）。了解有意义的“真阳性”线粒体小环状DNA（mt-sDNA）和粪便免疫化学检测（FIT）结果的频率，可优化这些结直肠癌（CRC）筛查检测的使用。我们使用以下定义计算了mt-sDNA和FIT队列的FDR（阳性粪便检测后结肠镜检查阴性的情况除以所有阳性粪便检测）和PPV：1）深度结肠镜检查研究（CRC、腺瘤/锯齿状息肉≥1厘米、绒毛状/高级别发育异常）；2）美国多学会特别工作组（USMSTF）随访时间<10年：深度结肠镜检查结果及≥1个直径<1厘米的无蒂锯齿状息肉（SSP，有/无发育异常）或≥1个直径<1厘米的管状腺瘤。3）具有临床意义：深度结肠镜检查结果+USMSTF+具有临床意义的锯齿状息肉：传统锯齿状腺瘤、SSP、直径>1厘米的增生性息肉（HP）以及5-9毫米的近端HP。样本包括549名mt-sDNA阳性和410名FIT阳性患者（平均年龄66.4岁，43.0%为男性）。使用最严格的阳性结肠镜检查定义，即深度结肠镜检查研究，mt-sDNA阳性的FDR为71.9%，FIT阳性的FDR为81.7%。使用USMSTF定义时，FDR大幅下降：mt-sDNA阳性为33.2%，FIT阳性为47.6%。加入所有具有临床意义的锯齿状息肉后，FDR最低：mt-sDNA阳性为32.2%，FIT阳性为47.1%。FDR的降低与PPV的增加相对应：mt-sDNA阳性为28.1%，FIT阳性为18.3%（深度结肠镜检查研究定义），mt-sDNA阳性为67.8%，FIT阳性为52.9%（深度结肠镜检查结果+USMSTF+具有临床意义的锯齿状息肉）（表1）。当阳性检查的定义包括所有重要的癌前病变结果时，FDR大幅下降。这些数据全面呈现了阳性粪便检测后结肠镜检查假阳性结果的情况，据我们所知，这是首次此类分析。
