J S Hunt1, C Cock2, E L Symonds3,4. 1. Department of Gastroenterology and Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Flinders Drive, Bedford Park, Adelaide, South Australia, 5042, Australia. james.hunt4@sa.gov.au. 2. Department of Gastroenterology and Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Flinders Drive, Bedford Park, Adelaide, South Australia, 5042, Australia. 3. Cancer Research, Flinders Health and Medical Research, Flinders University, Bedford Park, South Australia, Australia. 4. Bowel Health Service, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia.
Abstract
INTRODUCTION: Many colonoscopies following a positive fecal immunochemical test (FIT) will not identify a probable cause for fecal blood, and missed neoplasia is a concern. The study determined whether the absence of neoplasia at a FIT positive diagnostic colonoscopy was due to a missed lesion and whether the initial FIT hemoglobin (f-Hb) concentration could predict missed lesions. METHODS: This was a retrospective audit of patients who had undergone diagnostic colonoscopy after FIT screening (2 sample ≥ 20 µg Hb/g feces). Probable bleeding lesions including cancer, advanced adenoma, colitis, and angiodysplasia were considered a "positive colonoscopy outcome." For those with a negative outcome, findings at the subsequent colonoscopy were assessed. RESULTS: There were 1087 good quality colonoscopies within 12 months of a positive FIT. In total, 171 (15.7%) patients had a positive outcome at the diagnostic colonoscopy. Subsequent colonoscopies of negative outcome cases (n = 418, median of 3.1y later) were reviewed; of these, there were 57 (13.6%) cases with a positive outcome. This included CRC in 0.5% (n = 2) and advanced adenoma in 11.7% (n = 49). High f-Hb and having both FIT samples ≥ 20 µg/g feces were associated with a positive outcome at the original diagnostic colonoscopy (p < 0.05). However, f-Hb was not predictive for a positive outcome at the subsequent colonoscopy by either maximum f-Hb (p = 0.768), total f-Hb (p = 0.459), or both FIT samples ≥ 20 µg/g (p = 0.091). CONCLUSION: A small proportion of "false" positive FIT results had cancer or advanced adenoma found at the subsequent colonoscopy. A missed lesion could not be predicted by the initial FIT f-Hb.
INTRODUCTION: Many colonoscopies following a positive fecal immunochemical test (FIT) will not identify a probable cause for fecal blood, and missed neoplasia is a concern. The study determined whether the absence of neoplasia at a FIT positive diagnostic colonoscopy was due to a missed lesion and whether the initial FIT hemoglobin (f-Hb) concentration could predict missed lesions. METHODS: This was a retrospective audit of patients who had undergone diagnostic colonoscopy after FIT screening (2 sample ≥ 20 µg Hb/g feces). Probable bleeding lesions including cancer, advanced adenoma, colitis, and angiodysplasia were considered a "positive colonoscopy outcome." For those with a negative outcome, findings at the subsequent colonoscopy were assessed. RESULTS: There were 1087 good quality colonoscopies within 12 months of a positive FIT. In total, 171 (15.7%) patients had a positive outcome at the diagnostic colonoscopy. Subsequent colonoscopies of negative outcome cases (n = 418, median of 3.1y later) were reviewed; of these, there were 57 (13.6%) cases with a positive outcome. This included CRC in 0.5% (n = 2) and advanced adenoma in 11.7% (n = 49). High f-Hb and having both FIT samples ≥ 20 µg/g feces were associated with a positive outcome at the original diagnostic colonoscopy (p < 0.05). However, f-Hb was not predictive for a positive outcome at the subsequent colonoscopy by either maximum f-Hb (p = 0.768), total f-Hb (p = 0.459), or both FIT samples ≥ 20 µg/g (p = 0.091). CONCLUSION: A small proportion of "false" positive FIT results had cancer or advanced adenoma found at the subsequent colonoscopy. A missed lesion could not be predicted by the initial FIT f-Hb.
Authors: Thomas F Imperiale; Rachel N Gruber; Timothy E Stump; Thomas W Emmett; Patrick O Monahan Journal: Ann Intern Med Date: 2019-02-26 Impact factor: 25.391
Authors: Andrea Gini; Erik E L Jansen; Nadine Zielonke; Reinier G S Meester; Carlo Senore; Ahti Anttila; Nereo Segnan; Dominika Novak Mlakar; Harry J de Koning; Iris Lansdorp-Vogelaar Journal: Eur J Cancer Date: 2020-01-10 Impact factor: 9.162
Authors: Nam Hee Kim; Yoon Suk Jung; Jae Wan Lim; Jung Ho Park; Dong Il Park; Chong Il Sohn Journal: Gastrointest Endosc Date: 2019-01-23 Impact factor: 9.427
Authors: Jacques Ferlay; Isabelle Soerjomataram; Rajesh Dikshit; Sultan Eser; Colin Mathers; Marise Rebelo; Donald Maxwell Parkin; David Forman; Freddie Bray Journal: Int J Cancer Date: 2014-10-09 Impact factor: 7.396
Authors: Jeonghun Lee; Sung Won Park; You Sun Kim; Kyung Jin Lee; Hyun Sung; Pil Hun Song; Won Jae Yoon; Jeong Seop Moon Journal: Medicine (Baltimore) Date: 2017-07 Impact factor: 1.889
Authors: Graeme P Young; Erin L Symonds; James E Allison; Stephen R Cole; Callum G Fraser; Stephen P Halloran; Ernst J Kuipers; Helen E Seaman Journal: Dig Dis Sci Date: 2014-12-10 Impact factor: 3.199