Multitarget stool DNA testing for the prevention of colon cancer: outcomes in a large integrated healthcare system.,Gastrointestinal Endoscopy

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Multitarget stool DNA testing for the prevention of colon cancer: outcomes in a large integrated healthcare system.
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2020-01-02 , DOI: 10.1016/j.gie.2019.12.027
Nimish Vakil ₁ , Kristin Ciezki ₂ , Nadia Huq ₂ , Maharaj Singh ₃

Affiliation

Background and Aims

Multitarget stool DNA (MT-sDNA) testing is used in primary care as a screening test for colon cancer. Test effectiveness and patient compliance were examined in clinical practice.

Methods

We assessed outcomes of MT-sDNA testing in a cohort study conducted in a large integrated healthcare system comprising 15 hospitals and 150 outpatient clinics using advanced electronic data capture (Clarity2 [Epic, Verona, Wisc, USA] and REDCap [Encinitas, Calif, USA]) followed by manual chart review to confirm MT-sDNA test results and to monitor the outcomes of subsequent colonoscopy.

Results

A total of 6835 MT-sDNA tests were performed over 1 year between 2017 and 2018. Of 1242 patients (18%) who tested positive, 1109 (89%) were referred for colonoscopy, and 905 of them (73%) underwent colonoscopy. Eleven patients (<1%) with a positive test had colorectal cancer, 215 (17%) had advanced adenomas, 110 (9%) had serrated adenomas, and 546 (60%) patients had an adenoma. Of the 6835 patients tested, adenoma or cancer was found in 557 patients (8%). An advanced adenoma or cancer was found in 226 of 1242 patients with a positive test (18%). Nonadherence with colonoscopy after a positive test was high (21%), and the cost to detect 1 advanced adenoma or cancer was $38,849.

Conclusions

The frequency of adenoma detection by an MT-sDNA screening strategy is low, and many positive tests are not associated with significant findings at colonoscopy. Failure to follow a positive test with colonoscopy is a significant problem that needs to be considered when this screening strategy is adopted.

中文翻译：

用于预防结肠癌的多靶标粪便DNA测试：大型综合医疗系统的结果。

背景和目标

多目标粪便DNA（MT-sDNA）测试在初级保健中用作结肠癌的筛查测试。在临床实践中检查了测试的有效性和患者的依从性。

方法

我们在一项由大型综合医疗系统组成的队列研究中评估了MT-sDNA测试的结果，该系统包括15家医院和150家门诊诊所，使用先进的电子数据捕获功能（Clarity2 [Epic，Verona，Wisc，USA]和REDCap [Encinitas，Calif，USA] ]），然后进行手动图表审查，以确认MT-sDNA测试结果并监视后续结肠镜检查的结果。

结果

在2017年至2018年之间的1年中，总共进行了6835例MT-sDNA检测。在检测出阳性的1242例患者（18％）中，有1109例（89％）接受了结肠镜检查，其中905例（73％）接受了结肠镜检查。测试阳性的11例患者（<1％）有结直肠癌，晚期腺瘤为215（17％），锯齿状腺瘤为110（9％），腺瘤为546（60％）。在接受测试的6835名患者中，有557名患者（占8％）被发现有腺瘤或癌症。在1242名患者中的226名患者中发现了晚期腺瘤或癌症，其检测结果为阳性（18％）。阳性检查后结肠镜检查的不依从性很高（21％），检测到1例晚期腺瘤或癌症的费用为38,849美元。