Serrated Polyp Yield at Colonoscopy in Patients with Positive FIT, Positive mt-sDNA, and Colonoscopy Only: Data from the New Hampshire Colonoscopy Registry.
Serrated Polyp Yield at Colonoscopy in Patients with Positive FIT, Positive mt-sDNA, and Colonoscopy Only: Data from the New Hampshire Colonoscopy Registry.
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DOI：
10.1158/1055-9965.epi-22-0527
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发表时间：
2023-02-06
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影响因子：
--
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中科院分区：
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基于粪便的筛查，采用粪便免疫化学（FIT）或多靶点粪便DNA（mt - sDNA）检测，与结肠镜检查息肉检出率的提高相关。mt - sDNA检测包含甲基化标志物，相较于FIT，其对锯齿状息肉（SP）的检测能力有所提升。我们利用新罕布什尔结肠镜检查登记系统（一个全面的全州性基于人群的登记系统），对比了因FIT或mt - sDNA检测呈阳性而进行的结肠镜检查，以及未先行粪便检测的结肠镜检查中SP的检出情况。
在这三组人群中，我们比较了临床相关锯齿状息肉（CRSP：无蒂锯齿状息肉、直径≥10毫米的增生性息肉以及传统锯齿状腺瘤）的出现频率。我们还比较了SP的大小、组织学特征、数量及总体积（各息肉大小总和）。
我们的样本包括560名mt - sDNA检测阳性患者（年龄±标准差：66.5 ± 7.9岁）、414名FIT检测阳性患者（年龄±标准差：66.3 ± 8.8岁）以及59438名仅接受结肠镜检查的患者（年龄±标准差：61.7 ± 8.0岁）。与FIT检测阳性患者（P < 0.0001）或仅接受结肠镜检查的患者（P < 0.0001）相比，mt - sDNA检测阳性患者的CRSP检出率和CRSP总体积更高。更多mt - sDNA检测阳性患者存在CRSP，但无大腺瘤或结直肠癌（17.9%，而FIT检测阳性患者为9.9%，仅接受结肠镜检查的患者为8%）。在对同时存在的大腺瘤、结直肠癌及其他风险因素进行校正后，与FIT检测阳性患者相比，mt - sDNA检测阳性患者更有可能存在CRSP（优势比为1.82；95%置信区间为1.18 - 2.85）。
mt - sDNA检测阳性患者的SP检出率高于FIT检测阳性患者或仅接受结肠镜检查的患者，尤其是在不存在同时性大腺瘤或结直肠癌的情况下。
我们的研究结果表明，采用mt - sDNA检测进行筛查，能够通过识别更多来自锯齿状病变途径的高风险患者，从而改进结直肠癌的筛查工作。
Stool-based screening with fecal immunochemical (FIT) or multitarget-stool DNA (mt-sDNA) tests is associated with increased colonoscopy polyp yield. mt-sDNA includes methylated markers, which improve detection of serrated polyps (SP) versus FIT. We compared SP detection in colonoscopies performed for positive FIT or mt-sDNA tests, as well as in colonoscopies without a preceding stool test, using the New Hampshire Colonoscopy Registry, a comprehensive statewide population-based registry. Across the three groups, we compared the frequency of clinically relevant SPs (CRSP: sessile SPs, hyperplastic polyps ≥10 mm, and traditional serrated adenomas). We also compared SP size, histology, number, and bulk (combined sizes). Our sample included 560 mt-sDNA+ (age ± SD: 66.5 ± 7.9), 414 FIT+ (age ± SD: 66.3 ± 8.8), and 59,438 colonoscopy-only patients (age ± SD: 61.7 ± 8.0). mt-sDNA+ patients were more likely to have a higher yield of CRSPs and CRSP bulk than FIT+ (P < 0.0001) or colonoscopy-only patients (P < 0.0001). More mt-sDNA+ patients had CRSPs without large adenomas or colorectal cancers (17.9% vs. 9.9% of FIT+ and 8% of colonoscopy-only patients). After adjusting for synchronous large adenomas, colorectal cancers, and other risk factors, mt-sDNA+ patients were more likely (OR, 1.82; 95% CI, 1.18–2.85) than FIT+ patients to have CRSPs. mt-sDNA+ patients had a higher SP yield than FIT+ or colonoscopy-only patients, particularly in the absence of synchronous large adenomas or colorectal cancer. Our results suggest that screening with mt-sDNA tests could improve colorectal cancer screening by identifying more patients at increased risk from the serrated pathway.
影响因子：
3.4
作者：
Anderson JC
通讯作者：
Anderson JC