Martin C S Wong1, Jessica Y L Ching2, Siew C Ng3, Sunny Wong3, Victor C W Chan2, Jeffrey P Shum2, Thomas Y T Lam2, Arthur K C Luk2, Joseph J Y Sung2. 1. Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong. 2. Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong. 3. Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong Department of Medicine and Therapeutics, State Key laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong.
Abstract
OBJECTIVE: To compare the performance of existing sigmoidoscopy-based strategies in predicting advanced proximal neoplasia (APN) in an asymptomatic Chinese cohort. DESIGN: We included all screening participants aged 50-70 years who received colonoscopy between 2008 and 2014 in Hong Kong. Sigmoidoscopy yield was estimated from the colonoscopic findings based on the: (1) UK flexible sigmoidoscopy; (2) Screening for COlon REctum (SCORE); (3) NORwegian Colorectal Cancer Prevention (NORCCAP) trials and (4) US clinical index based on age, gender and distal findings. The sensitivity, specificity, the number of subjects needed to screen (NNS) and the number of subjects needed to refer (NNR) for colonoscopy to detect one APN were evaluated. Binary logistic regression modelling identified the distal findings associated with APN. RESULTS: From 5879 eligible subjects, 132 (2.2%) had APN. The US strategy achieved the highest sensitivity for APN detection (42.0%) and the UK criteria attained the highest specificity (96%). The US criteria led to the lowest NNS (92 vs 103-267) and the UK criteria required the least NNR (12 vs 16-21). Using the US strategy, the rates of APN detected were 1.4% (low-risk group), 2.2% (intermediate risk) and 5.9% (high risk). The c-statistics of the UK, SCORE, NORCCAP and the US criteria were 0.55±0.03; 0.59±0.03; 0.59±0.03 and 0.62±0.05 respectively. CONCLUSIONS: The US criteria had the highest sensitivity for detection of APN and lowest NNS and the UK score had the highest specificity and the lowest NNR. The performance of all these four criteria to predict APN is limited, highlighting an urgent need to devise a novel APN prediction system for Asian subjects. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVE: To compare the performance of existing sigmoidoscopy-based strategies in predicting advanced proximal neoplasia (APN) in an asymptomatic Chinese cohort. DESIGN: We included all screening participants aged 50-70 years who received colonoscopy between 2008 and 2014 in Hong Kong. Sigmoidoscopy yield was estimated from the colonoscopic findings based on the: (1) UK flexible sigmoidoscopy; (2) Screening for COlon REctum (SCORE); (3) NORwegian Colorectal Cancer Prevention (NORCCAP) trials and (4) US clinical index based on age, gender and distal findings. The sensitivity, specificity, the number of subjects needed to screen (NNS) and the number of subjects needed to refer (NNR) for colonoscopy to detect one APN were evaluated. Binary logistic regression modelling identified the distal findings associated with APN. RESULTS: From 5879 eligible subjects, 132 (2.2%) had APN. The US strategy achieved the highest sensitivity for APN detection (42.0%) and the UK criteria attained the highest specificity (96%). The US criteria led to the lowest NNS (92 vs 103-267) and the UK criteria required the least NNR (12 vs 16-21). Using the US strategy, the rates of APN detected were 1.4% (low-risk group), 2.2% (intermediate risk) and 5.9% (high risk). The c-statistics of the UK, SCORE, NORCCAP and the US criteria were 0.55±0.03; 0.59±0.03; 0.59±0.03 and 0.62±0.05 respectively. CONCLUSIONS: The US criteria had the highest sensitivity for detection of APN and lowest NNS and the UK score had the highest specificity and the lowest NNR. The performance of all these four criteria to predict APN is limited, highlighting an urgent need to devise a novel APN prediction system for Asian subjects. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Jason L W Huang; Y H Wang; Johnny Y Jiang; C P Yu; Y L Wu; P Chen; X Q Yuan; Harry H X Wang; Martin C S Wong Journal: Am J Gastroenterol Date: 2017-05-30 Impact factor: 10.864
Authors: Martin C S Wong; Jessica Y L Ching; Han-Mo Chiu; Kai Chun Wu; Rungsun Rerknimitr; Jingnan Li; Deng-Chiang Wu; Khean Lee Goh; Takahisa Matsuda; Hyun-Soo Kim; Rupert Leong; Khay Guan Yeoh; Vui Heng Chong; Jose D Sollano; Furqaan Ahmed; Jayaram Menon; Siew C Ng; Justin C Y Wu; Francis K L Chan; Joseph J Y Sung Journal: Am J Gastroenterol Date: 2016-03-15 Impact factor: 10.864
Authors: Martin C S Wong; Jessica Y L Ching; Victor C W Chan; Raymond S Y Tang; Arthur K C Luk; Thomas Y T Lam; Sunny S H Wong; Siew C Ng; Simon S M Ng; Justin C Y Wu; Francis K L Chan; Joseph J Y Sung Journal: Sci Rep Date: 2016-02-08 Impact factor: 4.379
Authors: Martin C S Wong; Jessica Y L Ching; Victor C W Chan; Thomas Y T Lam; Arthur K C Luk; Sunny H Wong; Siew C Ng; Simon S M Ng; Justin C Y Wu; Francis K L Chan; Joseph J Y Sung Journal: Medicine (Baltimore) Date: 2016-03 Impact factor: 1.889
Authors: Martin C S Wong; Jessica Y L Ching; Simpson Ng; Thomas Y T Lam; Arthur K C Luk; Sunny H Wong; Siew C Ng; Simon S M Ng; Justin C Y Wu; Francis K L Chan; Joseph J Y Sung Journal: Sci Rep Date: 2016-02-03 Impact factor: 4.379