TY - JOUR
T1 - Fecal Immunochemical Test to Detect Colorectal Neoplasia in Lynch Syndrome
T2 - A Prospective Multicenter Study
AU - van Liere, Elsa L.S.A.
AU - de Boer, Nanne K.H.
AU - van Leerdam, Monique E.
AU - Dekker, Evelien
AU - Jacobs, Maarten A.J.M.
AU - Jacob Koornstra, Jan
AU - Kuijvenhoven, Johan P.
AU - Lemmens, Margriet
AU - Meijer, Gerrit A.
AU - Spaander, Manon C.W.
AU - Carvalho, Beatriz
AU - Ramsoekh, Dewkoemar
N1 - Publisher Copyright:
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2024/8/20
Y1 - 2024/8/20
N2 - Introduction Colonoscopy surveillance for Lynch syndrome is burdensome and post-colonoscopy colorectal cancers (CRCs) still occur. The non-invasive fecal immunochemical test (FIT) might guide optimal colonoscopy intervals. Methods Prospective, multi-center observational study in which individuals with Lynch syndrome performed a quantitative FIT prior to high-quality surveillance colonoscopy. Diagnostic performance of FIT at various thresholds ≤20 μg Hb/g feces was assessed for relevant neoplasia, including advanced neoplasia (CRC, advanced adenomas [AA] and advanced serrated lesions [ASL]) and non-advanced adenomas (NAA). Results Of the 217 included individuals (59% female, median age 51y), 4 had CRC, 5 AA, 4 ASL and 57 NAA as most relevant neoplasia. The lowest FIT positivity threshold (2.5 μg Hb/g feces, 14% positivity rate) maximized detection: 4/4 CRCs, 4/5 AA, 1/4 ASL and 9/57 NAA were detected, resulting in a sensitivity and negative predictive value (NPV) of, respectively, 89% and 99% for CRC plus AA, 69% and 97% for advanced neoplasia, and 26% and 72% for all relevant neoplasia (91% specificity for all groups). At equal sensitivity and NPV, specificity for advanced neoplasia optimized to 94% at threshold 4.1 μg/g. Per 100 FITs at threshold 4.1 μg/g, 11 individuals would test positive and thus proceed to colonoscopy, 2 individuals with advanced neoplasia would be missed and 3 individuals would need colonoscopy to detect 1 advanced neoplasia. Discussion FIT at thresholds ≤ 4.1 μg Hb/g feces may be a promising strategy to postpone colonoscopy in approximately 9 out of 10 individuals with Lynch syndrome. Large validation studies that also provide gene variant-specific outcomes should be prioritized.
AB - Introduction Colonoscopy surveillance for Lynch syndrome is burdensome and post-colonoscopy colorectal cancers (CRCs) still occur. The non-invasive fecal immunochemical test (FIT) might guide optimal colonoscopy intervals. Methods Prospective, multi-center observational study in which individuals with Lynch syndrome performed a quantitative FIT prior to high-quality surveillance colonoscopy. Diagnostic performance of FIT at various thresholds ≤20 μg Hb/g feces was assessed for relevant neoplasia, including advanced neoplasia (CRC, advanced adenomas [AA] and advanced serrated lesions [ASL]) and non-advanced adenomas (NAA). Results Of the 217 included individuals (59% female, median age 51y), 4 had CRC, 5 AA, 4 ASL and 57 NAA as most relevant neoplasia. The lowest FIT positivity threshold (2.5 μg Hb/g feces, 14% positivity rate) maximized detection: 4/4 CRCs, 4/5 AA, 1/4 ASL and 9/57 NAA were detected, resulting in a sensitivity and negative predictive value (NPV) of, respectively, 89% and 99% for CRC plus AA, 69% and 97% for advanced neoplasia, and 26% and 72% for all relevant neoplasia (91% specificity for all groups). At equal sensitivity and NPV, specificity for advanced neoplasia optimized to 94% at threshold 4.1 μg/g. Per 100 FITs at threshold 4.1 μg/g, 11 individuals would test positive and thus proceed to colonoscopy, 2 individuals with advanced neoplasia would be missed and 3 individuals would need colonoscopy to detect 1 advanced neoplasia. Discussion FIT at thresholds ≤ 4.1 μg Hb/g feces may be a promising strategy to postpone colonoscopy in approximately 9 out of 10 individuals with Lynch syndrome. Large validation studies that also provide gene variant-specific outcomes should be prioritized.
UR - http://www.scopus.com/inward/record.url?scp=85202053188&partnerID=8YFLogxK
U2 - 10.14309/ajg.0000000000003043
DO - 10.14309/ajg.0000000000003043
M3 - Article
C2 - 39162771
AN - SCOPUS:85202053188
SN - 0002-9270
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
ER -
