Management of large polyps in a colorectal cancer screening program with fecal immunochemical test: a community- and population-based observational study

Abstract Background and study aims The aim of this study was to analyze presentation, management, and outcomes of large polyps (LPs; ≥ 20 mm) detected in a colorectal cancer (CRC) screening program using a quantitative fecal immunochemical test (FIT). Patients and methods This was a retrospective community- and population-based observational study of all LPs detected in patients aged 50 to 74 years between 2015 and 2019 during FIT-positive colonoscopies within the screening program organized in Alsace (France). Results Among 13,633 FIT-positive colonoscopies, 1256 LPs (8.5 % malignant and 51.8 % nonpedunculated) were detected by 102 community gastroenterologists in 1164 patients (one in 12 colonoscopies). The sensitivity of optical diagnosis of malignancy was 54 % for nonpedunculated and 27 % for pedunculated T1 CRCs. The endoscopic resection rate was 82.7 % (95 % confidence interval [CI] 80.3–84.9) for benign LPs (70.2 % [95 % CI 66.4–74.1]) nonpedunculated, 95.2 % [95 % CI 93.4–97.1] pedunculated), varying from 0 to 100 % depending on the endoscopist. It was correlated with cecal intubation (Pearson r = 0.49, P < 0.01) and adenoma detection rates (r = 0.25, P = 0.01). Most endoscopists did not refer patients to more experienced endoscopists, and as a result, 60 % to 90 % of 183 surgeries for benign LPs were unwarranted. Endoscopic resection was curative for 4.3 % (95 % CI 0.9–12.0) of nonpedunculated and 37.8 % (95 % CI 22.5–55.2) of pedunculated T1 CRCs. Overall, 22 endoscopic submucosal dissections had to be performed to avoid one surgery. Conclusions Compared with current recommendations, there is tremendous room for improvement in community endoscopy practices in the diagnosis and management of LPs. Detection and polypectomy competencies are correlated and highly variable among endoscopists. Endoscopic resection is curative for 83 % of benign LPs and 16 % of T1 CRCs.

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Management of large polyps in a colorectal cancer screening program with fecal immunochemical test: a population-based study

10.1101/2020.05.15.20103135 ◽

2020 ◽

Author(s):

Bernard Denis ◽

Isabelle Gendre ◽

Philippe Perrin ◽

Nicolas Tuzin ◽

Mathieu Pioche

Keyword(s):

Colorectal Cancer ◽

Endoscopic Resection ◽

Screening Program ◽

Population Based ◽

Fecal Immunochemical Test ◽

Cecal Intubation ◽

Population Based Study ◽

Cancer Screening Program ◽

Adenoma Detection ◽

Immunochemical Test

Objective: To analyze presentation, management and outcomes of large (≥ 20 mm) polyps (LPs) detected in a colorectal cancer (CRC) screening program using a fecal immunochemical test (FIT). Design: Retrospective population-based study of all LPs detected in patients aged 50-74 years between 2015 and 2019 during FIT-positive colonoscopies within the screening program organized in Alsace (France). Results: Among 13,633 FIT-positive colonoscopies, 1256 LPs (8.5% malignant and 51.8% non-pedunculated) were detected by 102 community gastroenterologists in 1164 patients (one in 12 colonoscopies). The sensitivity of optical diagnosis of malignancy was 54% for non-pedunculated and 27% for pedunculated T1 CRCs. Endoscopic resection rate was 82.7% [95% CI 80.3-84.9] for benign LPs (70.2% [95% CI 66.4-74.1] non-pedunculated, 95.2% [95% CI 93.4-97.1] pedunculated, p<0.001), varying from 0 to 100% depending on the endoscopist. It was correlated with cecal intubation (Pearson r = 0.49, p<0.01) and adenoma detection (r = 0.25, p=0.01) rates. Most endoscopists did not refer patients to more experienced endoscopists, so that 60 to 90% of 183 surgeries for benign LPs were unwarranted. Endoscopic resection was curative for 4.3% [95% CI 0.9-12.0] of non-pedunculated and 37.8% [95% CI 22.5-55.2] of pedunculated T1 CRCs. Overall, 22 endoscopic submucosal dissections had to be performed to avoid one surgery. Conclusion: Compared with current recommendations, there is tremendous room for improvement of community endoscopy practices for the diagnosis and management of LPs. Detection and polypectomy competencies are correlated and highly variable among endoscopists. Endoscopic resection is curative in 83% of benign LPs and 16% of T1 CRCs.

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Correlating Quantitative Fecal Immunochemical Test Results with Neoplastic Findings on Colonoscopy in a Population-Based Colorectal Cancer Screening Program: A Prospective Study

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2016/4650471 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Neal Shahidi ◽

Laura Gentile ◽

Lovedeep Gondara ◽

Jeremy Hamm ◽

Colleen E. McGahan ◽

...

Keyword(s):

Colorectal Cancer ◽

Screening Program ◽

Population Based ◽

Fecal Immunochemical Test ◽

Average Risk ◽

Health Authorities ◽

Cancer Screening Program ◽

Immunochemical Test ◽

A Prospective Study ◽

The Cost

Background and Aims. The Canadian Partnership Against Cancer (CPAC) recommends a fecal immunochemical test- (FIT-) positive predictive value (PPV) for all adenomas of ≥50%. We sought to assess FIT performance among average-risk participants of the British Columbia Colon Screening Program (BCCSP).Methods.From Nov-2013 to Dec-2014 consecutive participants of the BCCSP were assessed. Data was obtained from a prospectively collected database. A single quantitative FIT (NS-Plus, Alfresa Pharma Corporation, Japan) with a cut-off of ≥10 μg/g (≥50 ng/mL) was used.Results. 20,322 FIT-positive participants underwent CSPY. At a FIT cut-off of ≥10 μg/g (≥50 ng/mL) the PPV for all adenomas was 52.0%. Increasing the FIT cut-off to ≥20 μg/g (≥100 ng/mL) would increase the PPV for colorectal cancer (CRC) by 1.5% and for high-risk adenomas (HRAs) by 6.5% at a cost of missing 13.6% of CRCs and 32.4% of HRAs.Conclusions.As the NS-Plus FIT cut-off rises, the PPV for CRC and HRAs increases but at the cost of missed lesions. A cut-off of ≥10 μg/g (≥50 ng/mL) produces a PPV for all adenomas exceeding national recommendations. Health authorities need to take into consideration endoscopic resources when selecting a FIT positivity threshold.

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