scholarly journals Detection of advanced colorectal neoplasia and relative colonoscopy workloads using quantitative faecal immunochemical tests: an observational study exploring the effects of simultaneous adjustment of both sample number and test positivity threshold

2020 ◽  
Vol 7 (1) ◽  
pp. e000517
Author(s):  
Graeme P Young ◽  
Richard J Woodman ◽  
Erin Symonds
Keyword(s):  
Observational Study ◽  
Colorectal Neoplasia ◽  
Haemoglobin Concentration ◽  
Advanced Adenoma ◽  
Sample Number ◽  
Test Parameters ◽  
Advanced Colorectal Neoplasia ◽  
Advanced Adenomas ◽  
Simultaneous Adjustment ◽  
The Relationship

ObjectiveWhen screening for colorectal cancer (CRC) using quantitative faecal immunochemical tests (FIT), test parameters requiring consideration are the faecal haemoglobin concentration (f-Hb) positivity cut-off and the number of stools sampled. This observational study explored variation in f-Hb between samples and the relationship between sensitivity for advanced neoplasia (AN, cancer or advanced adenoma) and colonoscopy workload across a range of independently-adjusted parameter combinations.DesignQuantitative FIT data (OC-Sensor) were accessed from individuals undergoing personalised colonoscopic screening with an offer of 2-sample FIT in the intervening years. We estimated variation in f-Hb between samples in 12 710 completing 2-sample FIT, plus test positivity rates (colonoscopy workload) and sensitivity for AN according to parameter combinations in 4037 instances where FIT was done in the year preceding colonoscopy.ResultsThere was large within-subject variability between samples, with the ratio for the second to the first sample f-Hb ranging up to 18-fold for all cases, and up to 56-fold for AN cases. Sensitivity for AN was greatest at lower f-Hb cut-offs and/or using 2-sample FIT. Colonoscopy workload varied according to how parameters were combined. Using different cut-offs for 1-sample FIT and 2-sample FIT to return similar sensitivity, workload was less with 2-sample FIT when the sensitivity goal exceeded 35%.ConclusionVariation in f-Hb between samples is such that both parameters are crucial determinants of sensitivity and workload; independent adjustment of each should be considered. The 2-sample FIT approach is best for detecting advanced adenomas as well as CRC provided that the colonoscopy workload is feasible.

scholarly journals Long-Term Incidence of Advanced Colorectal Neoplasia in Patients with Serrated Polyposis Syndrome: Experience in a Single Academic Centre

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1066
Author(s):  
Daniel Rodríguez-Alcalde ◽  
Guillermo Castillo-López ◽  
Jorge López-Vicente ◽  
Luis Hernández ◽  
Mercedes Lumbreras-Cabrera ◽  
...  
Keyword(s):  
Total Colectomy ◽  
Colorectal Neoplasia ◽  
Elevated Risk ◽  
Advanced Adenoma ◽  
Polyposis Syndrome ◽  
Serrated Polyp ◽  
Advanced Colorectal Neoplasia ◽  
Median Interval

Serrated polyposis syndrome (SPS) implies a slightly elevated risk of colorectal cancer (CRC) during endoscopic follow-up, but its natural course is still not well known. The main objective of this study was to describe the long-term risk of developing advanced neoplasia (AN) in these patients. Until October 2020, individuals who fulfilled 2010 WHO criteria I and/or III for SPS were retrospectively recruited. We selected those under endoscopic surveillance after resection of all lesions >3 mm in a high-quality colonoscopy. We excluded patients with total colectomy at diagnosis and those with any interval between colonoscopies >3.5 years. We defined AN as advanced serrated polyp (≥10 mm and/or with dysplasia), advanced adenoma, or CRC. In 109 patients, 342 colonoscopies were performed (median = 3, median interval = 1.8 years) during a median follow-up after colonic clearance of 5.0 years. Five-year cumulative incidences of AN were 21.6% globally, and 5.6%, 10.8%, and 50.8% in patients who fulfilled criterion I, III, and both, respectively (p < 0.001). No CRC was diagnosed and only 1 (0.9%) patient underwent surgery. In conclusion, cumulative incidences of AN could be lower than previously described, at least in patients who fulfil the 2010 WHO criterion III alone. Therefore, low-risk individuals might benefit from less stringent surveillance.

Number of advanced adenomas on index colonoscopy: Important risk factor for metachronous advanced colorectal neoplasia

2018 ◽  
Vol 50 (6) ◽  
pp. 568-572 ◽  
Author(s):  
Soo-Kyung Park ◽  
Hyo-Joon Yang ◽  
Yoon Suk Jung ◽  
Jung Ho Park ◽  
Chong Il Sohn ◽  
...  
Keyword(s):  
Risk Factor ◽  
Colorectal Neoplasia ◽  
Important Risk Factor ◽  
Advanced Colorectal Neoplasia ◽  
Advanced Adenomas

Prospective colonoscopic study to investigate risk of colorectal neoplasms in first-degree relatives of patients with non-advanced adenomas

Gut ◽  
2019 ◽  
Vol 69 (2) ◽  
pp. 304-310 ◽  
Author(s):  
Siew C Ng ◽  
Moe Htet Kyaw ◽  
Bing Yee Suen ◽  
Yee Kit Tse ◽  
Martin C S Wong ◽  
...  
Keyword(s):  
Family History ◽  
Colorectal Neoplasms ◽  
Colorectal Neoplasia ◽  
Positive Family History ◽  
Cross Sectional Study ◽  
Advanced Adenoma ◽  
Degree Relative ◽  
Cross Sectional ◽  
History Of ◽  
Advanced Adenomas

ObjectiveThe risk associated with a family history of non-advanced adenoma (non-AA) is unknown. We determined the prevalence of colorectal neoplasms in subjects who have a first-degree relative (FDR) with non-AA compared with subjects who do not have an FDR with adenomas.DesignIn a blinded, cross-sectional study, consecutive subjects with newly diagnosed non-AA were identified from our colonoscopy database. 414 FDRs of subjects with non-AA (known as exposed FDRs; mean age 55.0±8.1 years) and 414 age and sex-matched FDRs of subjects with normal findings from colonoscopy (known as unexposed FDRs; mean age 55.2±7.8 years) underwent a colonoscopy from November 2015 to June 2018. One FDR per family was recruited. FDRs with a family history of colorectal cancer were excluded. The primary outcome was prevalence of advanced adenoma (AA). Secondary outcomes included prevalence of all adenomas and cancer.ResultsThe prevalence of AA was 3.9% in exposed FDRs and 2.4% in unexposed FDRs (matched OR (mOR)=1.67; 95% CI 0.72 to 3.91; p=0.238 adjusted for proband sex and proband age). Exposed FDRs had a higher prevalence of any adenomas (29.2% vs 18.6%; mOR=1.87; 95% CI 1.32 to 2.66; p<0.001) and non-AA (25.4% vs 16.2%; mOR=1.91; 95% CI 1.32 to 2.76; p=0.001). A higher proportion of exposed FDRs than unexposed FDRs (4.3% vs 2.2%; adjusted mOR=2.44; 95% CI 1.01 to 5.86; p=0.047) had multiple adenomas. No cancer was detected in both groups.ConclusionA positive family history of non-AA does not significantly increase the risk of clinically important colorectal neoplasia. The data support current guidelines which do not advocate earlier screening in individuals with a family history of non-AA.Trial registration numberNCT0252172.

scholarly journals Faecal haemoglobin concentration is related to detection of advanced colorectal neoplasia in the next screening round

2016 ◽  
Vol 24 (2) ◽  
pp. 62-68 ◽  
Author(s):  
Jayne Digby ◽  
Callum G Fraser ◽  
Francis A Carey ◽  
Robert H Diament ◽  
Margaret Balsitis ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Programme ◽  
Colorectal Neoplasia ◽  
Haemoglobin Concentration ◽  
Advanced Neoplasia ◽  
Negative Results ◽  
Adenoma Detection ◽  
Advanced Colorectal Neoplasia ◽  
Positive Results ◽  
Diagnostic Outcomes

Objective To examine associations between faecal haemoglobin concentrations below the cut-off used in colorectal cancer screening and outcomes in the next screening round. Methods In the Scottish Bowel Screening Programme, faecal haemoglobin concentrations and diagnostic outcomes were investigated for participants with a negative result (faecal haemoglobin concentrations < 80.0 µg Hb/g faeces), followed by a positive result within two years. Results Of 37,780 participants with negative results, at the next screening round, 556 (1.5%) screened positive and 30,293 (80.2%) negative. Initial median faecal haemoglobin concentrations (2.1 µg Hb/g faeces, IQR: 0.0–13.2) were higher in those with subsequent positive results than those with subsequent negative results (0.0 µg Hb/g faeces, IQR: 0.0–1.4; p < 0.0001). Using faecal haemoglobin concentrations 0.0–19.9 µg Hb/g faeces as reference, logistic regression analysis showed high adjusted odds ratios for advanced neoplasia (advanced neoplasia: colorectal cancer or higher risk adenoma) detection at the next round of 14.3 (95% CI: 8.9–23.1) in those with initial faecal haemoglobin concentrations 20.0–39.9 µg Hb/g faeces, and 38.0 (95% CI: 20.2–71.2) with 60.0–79.9 µg Hb/g faeces. Conclusions A higher proportion of participants with faecal haemoglobin concentrations of ≥ 20 µg Hb/g faeces had advanced neoplasia detected at the next round than participants with lower faecal haemoglobin concentrations. Although most relevant when using high faecal haemoglobin concentrations cut-offs, studies of faecal haemoglobin concentrations and outcomes over screening rounds may provide strategies to direct available colonoscopy towards those at highest risk.

scholarly journals Risk stratification for advanced colorectal neoplasia based on the findings of the index and first surveillance colonoscopies

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245211
Author(s):  
Munenori Honda ◽  
Hideaki Naoe ◽  
Ryosuke Gushima ◽  
Hideaki Miyamoto ◽  
Masakuni Tateyama ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Stratification ◽  
Retrospective Cohort ◽  
Colorectal Neoplasia ◽  
Advanced Adenoma ◽  
Time High Risk ◽  
Advanced Neoplasia ◽  
Advanced Colorectal Neoplasia ◽  
Surveillance Endoscopy ◽  
Subsequent Risk

Risk stratification by index colonoscopy is well established for first surveillance endoscopy, but whether the previous two colonoscopies affect the subsequent advanced neoplasias has not been established. Therefore, the subsequent risk based on the findings of the index and first surveillance colonoscopies were investigated. This retrospective, cohort study was conducted in two clinics and included participants who had undergone two or more colonoscopies after index colonoscopy. High-risk was defined as advanced adenoma (≥ 1 cm, or tubulovillous or villous histology, or high-grade dysplasia). Based on the findings of the index and first surveillance colonoscopies, patients were classified into four categories: category A (both colonoscopy findings were normal), category B (no high-risk findings both times), category C (one time high-risk finding), and category D (high-risk findings both times). The incidence of subsequent advanced neoplasia was examined in each category. A total of 13,426 subjects were included and surveyed during the study periods. The subjects in category D had the highest risk of advanced neoplasia (27.4%, n = 32/117). The subjects in category A had the lowest risk (4.0%, n = 225/5,583). The hazard ratio for advanced neoplasia of category D compared to category A was 9.90 (95% Confidence interval 6.82–14.35, P<0.001). Classification based on the findings of index and first surveillance colonoscopies more effectively stratifies the risk of subsequent advanced neoplasia, resulting in more proper allocation of colonoscopy resources after two consecutive colonoscopies.

scholarly journals Coexistent adenoma and serrated polyps on index colonoscopy and the risk of metachronous advanced colorectal neoplasia

2019 ◽  
Vol 07 (12) ◽  
pp. E1748-E1754 ◽  
Author(s):  
Soo-Kyung Park ◽  
Hak-Soo Kim ◽  
Hyo-Joon Yang ◽  
Yoon Suk Jung ◽  
Jung Ho Park ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
Colorectal Neoplasia ◽  
Advanced Adenoma ◽  
Serrated Adenoma ◽  
Serrated Polyps ◽  
Advanced Colorectal Neoplasia ◽  
Significant Difference ◽  
The Family ◽  
Risk Patients

Abstract Background and aims The family of serrated polyps (SP) includes hyperplastic polyps (HP), sessile serrated adenomas/polyps, and traditional serrated adenoma. We investigated whether SP synchronous with adenoma at index colonoscopy is associated with metachronous advanced colorectal neoplasia (CRN). Methods Patients with ≥ 1 adenoma on index colonoscopy and who had undergone a follow-up colonoscopy were included. The patients were divided into four groups according to the presence of SP and advanced adenoma (AA) on index colonoscopy (non-AA, non-AA + SP, AA, AA + SP). The cumulative incidence of metachronous advanced CRN at surveillance colonoscopy was compared between groups. Results Among a total of 2209 patients, the numbers of patients in the non-AA, non-AA + SP, AA, and AA + SP groups were 922, 441, 625, and 221, respectively. The cumulative incidence of metachronous advanced CRN was higher in patients in the AA + SP group than that in the AA group (P<0.001), and there was no significant difference between the non-AA + SP group and the non-AA group (P = 0.06). The cumulative incidence of metachronous advanced CRN at 3 years was 17.9 % [95 % confidence interval (CI) 8.0–27.6], 10.7 % [95 %CI 7.7–3.6], 3.5 % [95 %CI 1.3–5.6], and 3.4 % [95 %CI 2.0–4.7] in the AA + SP, AA, non-AA + SP, and non-AA group, respectively. In a multivariate analysis, overall SP [hazard ratio (HR) 2.24; 95 %CI 1.38–3.64, P = 0.001], proximal SP (HR 2.31; 95 %CI 1.32–4.08), and HP (HR 2.19; 95 %CI 1.35–3.57) were risk factors for metachronous advanced CRN in patients with AA on index colonoscopy. Conclusions Coexistent AA and SP on index colonoscopy significantly increased the risk of metachronous advanced CRN compared with AA alone. Further large prospective studies are needed to confirm whether more intensive follow-up improves outcomes in these high risk patients.

scholarly journals Yield and Efficiency of FIT Tests Alone vs. In Combination with Risk Factors for Colorectal Cancer Screening

2020 ◽  
Vol 3 ◽  
Author(s):  
Vasu Sheel ◽  
Leslie Azzis ◽  
Racehl Hinrichs ◽  
Thomas Imperiale
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Systematic Review ◽  
High Risk ◽  
Colorectal Neoplasia ◽  
Risk Groups ◽  
Fiscal Year ◽  
Advanced Colorectal Neoplasia ◽  
Immunochemical Test ◽  
Advanced Adenomas

Background: Although colonoscopy (CY) may be considered the best screening test for colorectal cancer (CRC), annual fecal immunochemical test (FIT), which quantifies fecal hemoglobin is a viable alternative. Countries and healthcare systems using FIT-based screening may need to prioritize which FIT positive persons requires CY sooner (e.g. within the same fiscal year). We conducted a systematic review of published literature to understand how the yield/positive predictive value (PPV) of FIT could be improved.   Study Design: We performed a search of electronic databases for articles published between 2015 and June 2020. Titles, abstracts, and full texts were independently screened. Included studies fulfilled predetermined criteria and had descriptive and quantitative data extracted. We identified studies comparing the yield of FIT for advanced colorectal neoplasia ([AN], CRC plus advanced adenomas) among FIT positive persons to the yield of AN when FIT is combined with risk factors (age, sex, BMI, etc.). Data were extracted to find yield and efficiency of FIT alone vs FIT plus risk factors among FIT positive persons.   Results: From 623 titles reviewed, 4 studies met inclusion criteria. The objective of the studies was to increase the yield of AN or CRC in FIT positive patients. The number needed to scope (NNS) among FIT positives to detect AN significantly decreased for each study when looking at high risk groups as yield/PPV increased. The yield with FIT alone ranged from 24% to 46% and the NNS from 2.2 to 4.1. With risk factors, yield and NNS among those at high risk were 33.2 % to 75.6% and from 1.3 to 3.0, respectively.  Conclusion and Potential Impact: This systematic review quantifies how risk factors improve the yield for AN in FIT positive persons, which is information required for countries and health care settings with limited resources that need to direct CY resources to FIT positive patients at high risk for AN.  

scholarly journals An evaluation of the SENTiFIT 270 analyser for quantitation of faecal haemoglobin in the investigation of patients with suspected colorectal cancer

2018 ◽  
Vol 56 (4) ◽  
pp. 625-633 ◽  
Author(s):  
Josep M. Auge ◽  
Cristina Rodriguez ◽  
Oihana Espanyol ◽  
Liseth Rivero ◽  
Silvia Sandalinas ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Standard Deviation ◽  
Confidence Interval ◽  
Colorectal Neoplasia ◽  
Advanced Adenoma ◽  
Predictive Values ◽  
Advanced Colorectal Neoplasia ◽  
Two Samples ◽  
Analytical Imprecision ◽  
Carry Over

Abstract Background: An evaluation of SENTiFIT® 270 (Sentinel Diagnostics, Italy; Sysmex, Spain) analyser for the quantitation of faecal haemoglobin (f-Hb) was performed. Methods: The analytical imprecision, linearity, carry over and f-Hb stability were determined. Evaluation of the diagnostic accuracy was performed on 487 patients. Results: Within-run and between-run imprecision ranged 1.7%–5.1% and 3.8%–6.2%, respectively. Linearity studies revealed a mean recovery of 101.1% (standard deviation, 6.7%) for all dilutions. No carry over was detected below 7650 μg Hb/g faeces. Decay of f-Hb in refrigerated samples ranged 0.2%–0.5% per day. f-Hb in patients with advanced colorectal neoplasia (ACRN) (colorectal cancer [CRC] plus advanced adenoma [AA]) were significantly higher than from those with a normal colonoscopy. Sensitivity for ACRN at f-Hb cutoffs from 10 to 60 μg Hb/g faeces ranged from 28.9% (95% confidence interval [CI], 21.7%–37.2%) to 46.5% (95% CI, 38.1%–55%), the specificity ranged from 85% (95% CI, 82.3%–87.3%) to 93.2% (95% CI, 91.2%–94.8%), positive predictive values for detecting CRC and AA ranged from 11.6% (95% CI, 7.6%–17.2%) to 20.6% (95% CI, 13.3%–30.3%) and from 34.7% (95% CI, 28.1%–42%) to 42.3% (95% CI, 32.4%–52.7%), respectively, and the negative predictive value for ACRN ranged from 90.2% (95% CI, 87.9%–92.2%) to 88.4% (95% CI, 86%–90.4%). Using two samples per patient sensitivity increased with a slight decrease in specificity. Conclusions: The analytical and clinical performances of SENTiFIT assay demonstrate a specific and accurate test for detecting ACRN in symptomatic patients and those undergoing surveillance.

Hemmkörperentwicklung bei Hämophilie-Patienten nach Präparate wechsel

2012 ◽  
Vol 32 (S 01) ◽  
pp. S39-S42 ◽  
Author(s):  
S. Kocher ◽  
G. Asmelash ◽  
V. Makki ◽  
S. Müller ◽  
S. Krekeler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Observational Study ◽  
Retrospective Observational Study ◽  
Frequent Change ◽  
Patient Age ◽  
Treatment Regimens ◽  
Patient Âgé ◽  
The Relationship ◽  
Observation Period

SummaryThe retrospective observational study surveys the relationship between development of inhibitors in the treatment of haemophilia patients and risk factors such as changing FVIII products. A total of 119 patients were included in this study, 198 changes of FVIII products were evaluated. Results: During the observation period of 12 months none of the patients developed an inhibitor, which was temporally associated with a change of FVIII products. A frequent change of FVIII products didn’t lead to an increase in inhibitor risk. The change between plasmatic and recombinant preparations could not be confirmed as a risk factor. Furthermore, no correlation between treatment regimens, severity, patient age and comorbidities of the patients could be found.

Usia Resiko Tinggi dan Perdarahan Post Partum

2018 ◽  
Vol 3 (2) ◽  
pp. 91
Author(s):  
Ani Media Harumi ◽  
Kasiati Kasiati
Keyword(s):  
High Risk ◽  
Post Partum ◽  
Chi Square ◽  
Sample Number ◽  
Chi Square Test ◽  
Study Population ◽  
Relationship Of ◽  
The Relationship

Abstract: The purpose of this study is to analyze the relationship of age high risk with the incidence ofbleeding post partum in dr. M. Soewandhie Surabaya hospital. This research is analytic with an approachof a sectional cross. The study population was all post partum mothers in the Dr. M. Soewandhie Surabayahospital in January 2016 to March 2017, which amounts to an average of 1840respondents while theresearch sample number 182. Measuring collection sheet data obtained by systematic random sampling.The Study was conducted Chi-Square test obtained mean count X2 (0,00) is less than á (0.05) thenH0 is rejected and H1 accepted it means that there is a relationship between the age of high risk withbleeding post partum. Conclusion, there is a relationship between the age of high risk with the incidenceof bleeding post partum in the Spaceof the Maternity room Dr. Moch. Soewandhie Surabayahospital.

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