Garg Rajat, Burke Carol A, Aggarwal Manik, Macaron Carole, Singh Amandeep, Kim Michelle K, Regueiro Miguel, Amit Bhatt, Chahal Prabhleen, Garg Shashank
Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, United States.
Internal Medicine, Cleveland Clinic Foundation, Cleveland, United States.
Endosc Int Open. 2024 Apr 5;12(4):E474-E487. doi: 10.1055/a-2256-3411. eCollection 2024 Apr.
Published studies report a higher adenoma detection rate (ADR) for FIT-DNA as compared with FIT. Data are less replete about the performance of stool-based tests for sessile serrated polyp (SSP) detection. We performed a meta-analysis to evaluate the performance of FIT and FIT-DNA testing for SSP detection rate (SSPDR) in patients undergoing colonoscopy for follow up of positive noninvasive tests. A comprehensive literature search of multiple databases (until September 2022) was performed to identify studies reporting SSPDR in patients with positive FIT or FIT-DNA tests. The outcome was overall colonoscopy detection of any SSPs and advanced serrated polyps (ASP: SSP ≥ 10 mm and/or dysplasia). Included were 482,405 patients (52.4% females) with a mean age of 62.3 ± 4.4 years from 23 studies. The pooled SSPDR for all positive stool-based tests was 5.3% and higher for FIT-DNA (15.0%, 95% confidence interval [CI] 8.3-25.7) versus FIT (4.1%, 95% CI 3.0-5.6; = 0.0002). The overall pooled ASP detection rate was 1.4% (95% CI 0.81-2.3) and higher for FIT-DNA (3.8 %, 95% CI 1.7-8.6) compared with FIT (0.71%, 95% CI 0.36-1.4; <0.01). SSPDR with FIT-DNA was also significantly higher than FIT when the FIT cutoff was >10 ug/g and in FIT-positive patients in studies conducted in North America ( <0.05). FIT-DNA outperformed FIT in both SSP and ASP detection including FIT with a lower threshold cutoff of >10 ug/g. Further comparative studies are needed to assess the impact of our findings on colorectal cancer reduction.
已发表的研究报告称，与粪便免疫化学检测（FIT）相比，基于粪便DNA的检测（FIT-DNA）腺瘤检出率（ADR）更高。关于基于粪便检测对无蒂锯齿状息肉（SSP）的检测性能的数据较少。我们进行了一项荟萃分析，以评估在接受结肠镜检查以随访非侵入性检测阳性患者时，FIT和FIT-DNA检测对SSP检出率（SSPDR）的性能。对多个数据库进行了全面的文献检索（截至2022年9月），以确定报告FIT或FIT-DNA检测阳性患者SSPDR的研究。结果是结肠镜检查对任何SSP和高级别锯齿状息肉（ASP：SSP≥10毫米和/或发育异常）的总体检测情况。纳入了来自23项研究的482405名患者（52.4%为女性），平均年龄为62.3±4.4岁。所有基于粪便的阳性检测的汇总SSPDR为5.3%，FIT-DNA的SSPDR更高（15.0%，95%置信区间[CI]8.3-25.7），而FIT为（4.1%，95%CI 3.0-5.6；P=0.0002）。总体汇总ASP检出率为1.4%（95%CI 0.81-2.3），FIT-DNA的ASP检出率（3.8%，95%CI 1.7-8.6）高于FIT（0.71%，95%CI 0.36-1.4；P<0.01）。当FIT临界值>10微克/克时，以及在北美进行的研究中FIT阳性患者中，FIT-DNA的SSPDR也显著高于FIT（P<0.05）。在SSP和ASP检测方面，FIT-DNA均优于FIT，包括临界值较低>10微克/克的FIT。需要进一步的比较研究来评估我们的发现对降低结直肠癌的影响。
