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Lacroute J, Marcantoni J, Petitot S, Weber J, Levy P, Dirrenberger B, Tchoumak I, Baron M, Gibert S, Marguerite S, Huppertz J, Gronier O, Derlon A. The carbon footprint of ambulatory gastrointestinal endoscopy. Endoscopy 2023; 55:918-926. [PMID: 37156511 PMCID: PMC10533215 DOI: 10.1055/a-2088-4062] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Endoscopy is considered the third highest generator of waste within healthcare. This is of public importance as approximately 18 million endoscopy procedures are performed yearly in the USA and 2 million in France. However, a precise measure of the carbon footprint of gastrointestinal endoscopy (GIE) is lacking. METHODS This retrospective study for 2021 was conducted in an ambulatory GIE center in France where 8524 procedures were performed on 6070 patients. The annual carbon footprint of GIE was calculated using "Bilan Carbone" of the French Environment and Energy Management Agency. This multi-criteria method accounts for direct and indirect greenhouse gas (GHG) emissions from energy consumption (gas and electricity), medical gases, medical and non-medical equipment, consumables, freight, travel, and waste. RESULTS GHG emissions in 2021 were estimated to be 241.4 tonnes CO2 equivalent (CO2e) at the center, giving a carbon footprint for one GIE procedure of 28.4 kg CO2e. The main GHG emission, 45 % of total emissions, was from travel by patients and center staff to and from the center. Other emission sources, in rank order, were medical and non-medical equipment (32 %), energy consumption (12 %), consumables (7 %), waste (3 %), freight (0.4 %), and medical gases (0.005 %). CONCLUSIONS This is the first multi-criteria analysis assessing the carbon footprint of GIE. It highlights that travel, medical equipment, and energy are major sources of impact, with waste being a minor contributor. This study provides an opportunity to raise awareness among gastroenterologists of the carbon footprint of GIE procedures.
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Affiliation(s)
- Joël Lacroute
- Department of Gastroenterology, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
- Department of Gastroenterology, Clinique Sainte Barbe, Strasbourg, France
| | - Juliette Marcantoni
- Department of Anaesthesiology and Reanimation, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
- Department of Anaesthesiology and Reanimation, CHU, Strasbourg, France
| | | | | | - Patrick Levy
- Department of Gastroenterology, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
| | - Bastien Dirrenberger
- Department of Gastroenterology, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
| | - Irina Tchoumak
- Department of Gastroenterology, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
| | - Mathilde Baron
- Department of Anaesthesiology and Reanimation, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
| | - Stéphanie Gibert
- Department of Anaesthesiology and Reanimation, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
| | - Sandrine Marguerite
- Department of Anaesthesiology and Reanimation, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
| | - Jérôme Huppertz
- Department of Gastroenterology, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
| | - Olivier Gronier
- Department of Gastroenterology, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
| | - Anne Derlon
- Department of Gastroenterology, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
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Petersen MM, Kleif J, Jørgensen LN, Hendel JW, Seidelin JB, Madsen MR, Vilandt J, Brandsborg S, Rasmussen JS, Andersen LM, Khalid A, Ferm L, Gawel SH, Martens F, Andersen B, Rasmussen M, Davis GJ, Christensen IJ, Therkildsen C. Optimizing Screening for Colorectal Cancer: An Algorithm Combining Fecal Immunochemical Test, Blood-Based Cancer-Associated Proteins and Demographics to Reduce Colonoscopy Burden. Clin Colorectal Cancer 2023; 22:199-210. [PMID: 36878807 DOI: 10.1016/j.clcc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Fecal Immunochemical Test (FIT) is widely used in population-based screening for colorectal cancer (CRC). This had led to major challenges regarding colonoscopy capacity. Methods to maintain high sensitivity without compromising the colonoscopy capacity are needed. This study investigates an algorithm that combines FIT result, blood-based biomarkers associated with CRC, and individual demographics, to triage subjects sent for colonoscopy among a FIT positive (FIT+) screening population and thereby reduce the colonoscopy burden. MATERIALS AND METHODS From the Danish National Colorectal Cancer Screening Program, 4048 FIT+ (≥100 ng/mL Hemoglobin) subjects were included and analyzed for a panel of 9 cancer-associated biomarkers using the ARCHITECT i2000. Two algorithms were developed: 1) a predefined algorithm based on clinically available biomarkers: FIT, age, CEA, hsCRP and Ferritin; and 2) an exploratory algorithm adding additional biomarkers: TIMP-1, Pepsinogen-2, HE4, CyFra21-1, Galectin-3, B2M and sex to the predefined algorithm. The diagnostic performances for discriminating subjects with or without CRC in the 2 models were benchmarked against the FIT alone using logistic regression modeling. RESULTS The discrimination of CRC showed an area under the curve (AUC) of 73.7 (70.5-76.9) for the predefined model, 75.3 (72.1-78.4) for the exploratory model, and 68.9 (65.5-72.2) for FIT alone. Both models performed significantly better (P < .001) than the FIT model. The models were benchmarked vs. FIT at cutoffs of 100, 200, 300, 400, and 500 ng/mL Hemoglobin using corresponding numbers of true positives and false positives. All performance metrics were improved at all cutoffs. CONCLUSION A screening algorithm including a combination of FIT result, blood-based biomarkers and demographics outperforms FIT in discriminating subjects with or without CRC in a screening population with FIT results above 100 ng/mL Hemoglobin.
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Affiliation(s)
- Mathias M Petersen
- Gastro Unit, Hvidovre Hospital, Hvidovre, Denmark; Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Jakob Kleif
- Gastro Unit, Hvidovre Hospital, Hvidovre, Denmark; Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Surgery, Nordsjællands Hospital, Hillerød, Denmark
| | - Lars N Jørgensen
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jakob W Hendel
- Gastro Unit, Section for Gastroenterology, Herlev Hospital, Herlev, Denmark
| | - Jakob B Seidelin
- Gastro Unit, Section for Gastroenterology, Herlev Hospital, Herlev, Denmark
| | | | - Jesper Vilandt
- Department of Surgery, Nordsjællands Hospital, Hillerød, Denmark
| | | | | | - Lars M Andersen
- Department of Public Health Programmes and University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Ali Khalid
- Department of Surgery, Viborg Hospital, Viborg, Denmark
| | - Linnea Ferm
- Gastro Unit, Hvidovre Hospital, Hvidovre, Denmark
| | - Susan H Gawel
- Abbott Laboratories, Abbott Diagnostics Division, Abbott Park, IL
| | - Frans Martens
- Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam UMC, AMC & VUMC, Amsterdam, The Netherlands
| | - Berit Andersen
- Department of Public Health Programmes and University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten Rasmussen
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gerard J Davis
- Abbott Laboratories, Abbott Diagnostics Division, Abbott Park, IL
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Early detection of colorectal neoplasia: application of a blood-based serological protein test on subjects undergoing population-based screening. Br J Cancer 2022; 126:1387-1393. [PMID: 35091694 PMCID: PMC9090749 DOI: 10.1038/s41416-022-01712-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/17/2021] [Accepted: 01/20/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Blood-based biomarkers used for colorectal cancer screening need to be developed and validated in appropriate screening populations. We aimed to develop a cancer-associated protein biomarker test for the detection of colorectal cancer in a screening population. METHODS Participants from the Danish Colorectal Cancer Screening Program were recruited. Blood samples were collected prior to colonoscopy. The cohort was divided into training and validation sets. We present the results of model development using the training set. Age, sex, and the serological proteins CEA, hsCRP, TIMP-1, Pepsinogen-2, HE4, CyFra21-1, Galectin-3, ferritin and B2M were used to develop a signature test to discriminate between participants with colorectal cancer versus all other findings at colonoscopy. RESULTS The training set included 4048 FIT-positive participants of whom 242 had a colorectal cancer. The final model for discriminating colorectal cancer versus all other findings at colonoscopy had an AUC of 0.70 (95% CI: 0.66-0.74) and included age, sex, CEA, hsCRP, HE4 and ferritin. CONCLUSION The performance of the biomarker signature in this FIT-positive screening population did not reflect the positive performance of biomarker signatures seen in symptomatic populations. Additional biomarkers are needed if the serological biomarkers are to be used as a frontline screening test.
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Wu WM, Gu K, Yang YH, Bao PP, Gong YM, Shi Y, Xu WH, Fu C. Improved risk scoring systems for colorectal cancer screening in Shanghai, China. Cancer Med 2022; 11:1972-1983. [PMID: 35274820 PMCID: PMC9089226 DOI: 10.1002/cam4.4576] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/13/2021] [Accepted: 01/03/2022] [Indexed: 12/16/2022] Open
Abstract
Background An optimal risk‐scoring system enables more targeted offers for colonoscopy in colorectal cancer (CRC) screening. This analysis aims to develop and validate scoring systems using parametric and non‐parametric methods for average‐risk populations. Methods Screening data of 807,695 subjects and 2806 detected cases in the first‐round CRC screening program in Shanghai were used to develop risk‐predictive models and scoring systems using logistic‐regression (LR) and artificial‐neural‐network (ANN) methods. Performance of established scoring systems was evaluated using area under the receiver operating characteristic curve (AUC), calibration, sensitivity, specificity, number of high‐risk individuals and potential detection rates of CRC. Results Age, sex, CRC in first‐degree relatives, chronic diarrhoea, mucus or bloody stool, history of any cancer and faecal‐immunochemical‐test (FIT) results were identified as predictors for the presence of CRC. The AUC of LR‐based system was 0.642 when using risk factors only in derivation set, and increased to 0.774 by further incorporating one‐sample FIT results, and to 0.808 by including two‐sample FIT results, while those for ANN‐based systems were 0.639, 0.763 and 0.805, respectively. Better calibrations were observed for the LR‐based systems than the ANN‐based ones. Compared with the currently used initial tests, parallel use of FIT with LR‐based systems resulted in improved specificities, less demands for colonoscopy and higher detection rates of CRC, while parallel use of FIT with ANN‐based systems had higher sensitivities; incorporating FIT in the scoring systems further increased specificities, decreased colonoscopy demands and improved detection rates of CRC. Conclusions Our results indicate the potentials of LR‐based scoring systems incorporating one‐ or two‐sample FIT results for CRC mass screening. External validation is warranted for scaling‐up implementation in the Chinese population. The established scoring systems derived from the logistic regression (LR) models, incorporating one‐ or two‐sample faecal immunochemical test (FIT) results as a predictor, have the potential to triage high‐risk individuals for colonoscopy in mass screening of colorectal cancer (CRC). More importantly, the cut‐off points of the scoring systems can be adjusted flexibly, facilitating the choices of cut‐off values for populations with abundant or limited resources.
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Affiliation(s)
- Wei-Miao Wu
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
| | - Kai Gu
- Shanghai Municipal Center for Disease Control & Prevention, Shanghai, China
| | - Yi-Hui Yang
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
| | - Ping-Ping Bao
- Shanghai Municipal Center for Disease Control & Prevention, Shanghai, China
| | - Yang-Ming Gong
- Shanghai Municipal Center for Disease Control & Prevention, Shanghai, China
| | - Yan Shi
- Shanghai Municipal Center for Disease Control & Prevention, Shanghai, China
| | - Wang-Hong Xu
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
| | - Chen Fu
- Shanghai Municipal Center for Disease Control & Prevention, Shanghai, China
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Petersen MM, Ferm L, Kleif J, Piper TB, Rømer E, Christensen IJ, Nielsen HJ. Triage May Improve Selection to Colonoscopy and Reduce the Number of Unnecessary Colonoscopies. Cancers (Basel) 2020; 12:E2610. [PMID: 32932734 PMCID: PMC7563245 DOI: 10.3390/cancers12092610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 12/18/2022] Open
Abstract
Implementation of population screening for colorectal cancer by direct colonoscopy or follow-up colonoscopy after a positive fecal blood test has challenged the overall capacity of bowel examinations. Certain countries are facing serious colonoscopy capacity constraints, which have led to waiting lists and long time latency of follow-up examinations. Various options for improvement are considered, including increased cut-off values of the fecal blood tests. Results from major clinical studies of blood-based, cancer-associated biomarkers have, however, led to focus on a Triage concept for improved selection to colonoscopy. The Triage test may include subject age, concentration of hemoglobin in a feces test and a combination of certain blood-based cancer-associated biomarkers. Recent results have indicated that Triage may reduce the requirements for colonoscopy by around 30%. Such results may be advantageous for the capacity, the healthcare budgets and in particular, the subjects, who do not need an unnecessary, unpleasant and risk-associated bowel examination.
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Affiliation(s)
- Mathias M. Petersen
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Linnea Ferm
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Jakob Kleif
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Thomas B. Piper
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Eva Rømer
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Ib J. Christensen
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Hans J. Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
- Institute of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
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Mocciaro F, Scimeca D, Conte E, Bonaccorso A, Di Mitri R. Colorectal cancer screening and diagnosis: from desirable excellence to the dark side of clinical reality. Dig Liver Dis 2020; 52:1063-1064. [PMID: 32553698 DOI: 10.1016/j.dld.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/05/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Leotta n. 4, 90100, Palermo, Italy
| | - Daniela Scimeca
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Leotta n. 4, 90100, Palermo, Italy.
| | - Elisabetta Conte
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Leotta n. 4, 90100, Palermo, Italy
| | - Ambra Bonaccorso
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Leotta n. 4, 90100, Palermo, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Leotta n. 4, 90100, Palermo, Italy
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Lech Pedersen N, Mertz Petersen M, Ladd JJ, Lampe PD, Bresalier RS, Davis GJ, Demuth C, Jensen SØ, Andersen CL, Ferm L, Christensen IJ, Nielsen HJ. Development of blood-based biomarker tests for early detection of colorectal neoplasia: Influence of blood collection timing and handling procedures. Clin Chim Acta 2020; 507:39-53. [PMID: 32272156 DOI: 10.1016/j.cca.2020.03.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Blood-based, cancer-associated biomarkers are susceptible to a variety of well-known preanalytical factors. The influence of bowel preparation before a diagnostic colonoscopy on biomarker levels is, however, poorly investigated. The present study assessed the influence of bowel preparation on colorectal cancer-associated biomarkers. In addition, the effect of single versus double centrifugation of plasma biomarkers was assessed. METHODS Blood samples were collected pre- and post-bowel preparation from 125 subjects scheduled for first time diagnostic colonoscopy due to symptoms attributable to CRC. The samples were separated into serum and EDTA plasma, and analyzed by four independent collaborators for: 1) the proteins AFP, CA19-9, CEA, hs-CRP, CyFra21-1, Ferritin, Galectin-3 and TIMP-1, 2) the proteins BAG4, IL6ST, vWF, CD44 and EGFR, 3) the glycoprotein Galectin-3 ligand, and 4) cell-free DNA (cfDNA). Statistical analysis of biomarker data has been performed using mixed modelling, including repeated measures. RESULTS The biomarkers generally showed negligible variation between pre- and post-bowel preparation except for CyFra21-1, Ferritin, BAG4 and cfDNA. CyFra21-1 levels were systematically reduced with 29% (95% CI 21-36%) by bowel preparation (p ≤ 0.0001). Ferritin was not significantly different between pre- and post-bowel preparation (p = 0.07), however the estimated difference (increase) was 18%. BAG4 was systematically reduced by 12% (95% CI 1-22%, p = 0.04), while cfDNA showed a significant increase of 28% (95% CI 17-39%, p < 0.0001). Double centrifugation compared to single centrifugation showed reduced vWF (ratio 0.86, p ≤ 0.0001) and CD44 (ratio 0.85, p = 0.016), but increased IL6ST levels (ratio 1.18, p = 0.014). CONCLUSIONS Results of the present study demonstrated systematic, statistically significant differences between pre-bowel and post-bowel preparation levels for three independent blood-based biomarkers (BAG4, CyFra21-1, cfDNA), illustrating the importance of timing of sample collection for biomarker analyses.
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Affiliation(s)
- Niels Lech Pedersen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Mathias Mertz Petersen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark. http://www.colorectalcancer.dk
| | - Jon J Ladd
- Translational Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Paul D Lampe
- Translational Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Robert S Bresalier
- Department of Gastroenterology, Hepatology & Nutrition, MD Anderson Cancer Center, Houston, TX, USA
| | - Gerard J Davis
- Abbott Laboratories Inc., Cancer Core R&D, Abbott Park, IL, USA
| | - Christina Demuth
- Department of Molecular Medicine, Aarhus University Hospital, Skejby, Denmark
| | - Sarah Ø Jensen
- Department of Molecular Medicine, Aarhus University Hospital, Skejby, Denmark
| | - Claus L Andersen
- Department of Molecular Medicine, Aarhus University Hospital, Skejby, Denmark
| | - Linnea Ferm
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Ib J Christensen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Hans J Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Jensen SØ, Øgaard N, Ørntoft MBW, Rasmussen MH, Bramsen JB, Kristensen H, Mouritzen P, Madsen MR, Madsen AH, Sunesen KG, Iversen LH, Laurberg S, Christensen IJ, Nielsen HJ, Andersen CL. Novel DNA methylation biomarkers show high sensitivity and specificity for blood-based detection of colorectal cancer-a clinical biomarker discovery and validation study. Clin Epigenetics 2019; 11:158. [PMID: 31727158 PMCID: PMC6854894 DOI: 10.1186/s13148-019-0757-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/02/2019] [Indexed: 02/06/2023] Open
Abstract
Background Early detection plays an essential role to reduce colorectal cancer (CRC) mortality. While current screening methods suffer from poor compliance, liquid biopsy-based strategies for cancer detection is rapidly gaining promise. Here, we describe the development of TriMeth, a minimal-invasive blood-based test for detection of early-stage colorectal cancer. The test is based on assessment of three tumour-specific DNA methylation markers in circulating cell-free DNA. Results A thorough multi-step biomarker discovery study based on DNA methylation profiles of more than 5000 tumours and blood cell populations identified CRC-specific DNA methylation markers. The DNA methylation patterns of biomarker candidates were validated by bisulfite sequencing and methylation-specific droplet digital PCR in CRC tumour tissue and peripheral blood leucocytes. The three best performing markers were first applied to plasma from 113 primarily early-stage CRC patients and 87 age- and gender-matched colonoscopy-verified controls. Based on this, the test scoring algorithm was locked, and then TriMeth was validated in an independent cohort comprising 143 CRC patients and 91 controls. Three DNA methylation markers, C9orf50, KCNQ5, and CLIP4, were identified, each capable of discriminating plasma from colorectal cancer patients and healthy individuals (areas under the curve 0.86, 0.91, and 0.88). When combined in the TriMeth test, an average sensitivity of 85% (218/256) was observed (stage I: 80% (33/41), stage II: 85% (121/143), stage III: 89% (49/55), and stage IV: 88% (15/17)) at 99% (176/178) specificity in two independent plasma cohorts. Conclusion TriMeth enables detection of early-stage colorectal cancer with high sensitivity and specificity. The reported results underline the potential utility of DNA methylation-based detection of circulating tumour DNA in the clinical management of colorectal cancer.
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Affiliation(s)
- Sarah Østrup Jensen
- Department of Molecular Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Nadia Øgaard
- Department of Molecular Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Mai-Britt Worm Ørntoft
- Department of Molecular Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Mads Heilskov Rasmussen
- Department of Molecular Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Jesper Bertram Bramsen
- Department of Molecular Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | | | | | | | | | | | | | - Søren Laurberg
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Ib Jarle Christensen
- Center for Surgical Research, Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Hans Jørgen Nielsen
- Center for Surgical Research, Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Claus Lindbjerg Andersen
- Department of Molecular Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
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