Evidence supports higher adenoma detection targets for FIT-positive colonoscopies
Evidence from a multicenter cohort study revealed that adenoma detection rates were higher in colonoscopies performed following positive results from a fecal immunochemical test compared with direct screening colonoscopies.
John C.T. Wong, MD, of the Institute of Digestive Disease at the Chinese University of Hong Kong, and colleagues wrote that their findings, published in Gastrointestinal Endoscopy, supported recommendations to raise targets for ADR above the current benchmark of 25%. The United States Multi-Society Task Force on Colorectal Cancer recently recommended ADR benchmarks of more than 45% for men and more than 35% for women.
“However as graded by the task force, this recommendation is supported by low quality evidence,” Wong and colleagues wrote. “Establishing a reliable measure for quality FIT positive colonoscopy is crucial in organized screening programs to ensure quality.”
Researchers identified asymptomatic, average-risk patients who underwent screening colonoscopy directly (n = 2,901; 57% men) or as a follow-up to a positive FIT (n = 2,485; 57% men) from eight centers across the Asia Pacific region. They compared ADR, advanced ADR and adenoma per colonoscopy between both screening methods.
Investigators found that ADR was higher in colonoscopies performed following positive FIT compared with direct screening colonoscopies overall (53.6% vs. 37.5%; OR = 1.93; P < .001), in men (61.6% vs. 44.6%; OR = 2; P < .001) and in women (43.2% vs. 28.2%; OR = 1.94; P < .001). Advanced ADR was also higher in FIT-positive colonoscopies (29.9% vs. 4.9%; OR = 8.2; P < .001).
Additionally, researchers found that ADR was positively correlated with adenomas per colonoscopy. Detection rates of 45% and 35% correlated to adenoma per colonoscopy of approximately 1 and approximately 0.65, respectively.
“Our findings contribute to the evidence in support of the higher ADR targets in [FIT positive colonoscopies] recently proposed by the British, Spanish and [United States Multi-Society Task Force],” Wong and colleagues wrote. “The establishment of appropriate ADR targets for subjects with a positive FIT is crucial in a two-step CRC screening program as a quality assurance measurement.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.