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Toyoshima O, Nishizawa T, Hiramatsu T, Matsuno T, Yoshida S, Mizutani H, Ebinuma H, Matsuda T, Saito Y, Fujishiro M. Colorectal adenoma detection rate using texture and color enhancement imaging versus white light imaging with chromoendoscopy: a propensity score matching study. J Gastroenterol Hepatol 2024. [PMID: 38872367 DOI: 10.1111/jgh.16655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/07/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND AND AIM Few studies have evaluated the adenoma detection rate (ADR) of colonoscopy with texture and color enhancement imaging (TXI), a novel image-enhancing technology. This study compares the detection of colorectal polyps using TXI to that using white light imaging (WLI). METHODS This single-center retrospective study used propensity-matched scoring based on the patients' baseline characteristics (age, sex, indication, bowel preparation, endoscopist, colonoscope type, and withdrawal time) to compare the results of patients who underwent chromoendoscopy using WLI or TXI at the Toyoshima Endoscopy Clinic. The differences in polyp detection rates and the mean number of detected polyps per colonoscopy were determined between the TXI and WLI groups. RESULTS After propensity score matching, 1970 patients were enrolled into each imaging modality group. The mean patient age was 57.2 ± 12.5 years, and 44.5% of the cohort were men. The ADR was higher in the TXI group than in the WLI group (55.0% vs 49.4%, odds ratio: 1.25). High-risk ADR were more common in the TXI group than in the WLI group (17.6% vs 12.8%; OR: 1.45). The mean number of adenomas per colonoscopy (APC) was higher in the TXI group than in the WLI group (1.187 vs 0.943, OR: 1.12). APC with a flat morphology (1.093 vs 0.848, OR: 1.14) and APC of <6 mm (0.992 vs 0.757, OR: 1.16) were higher in the TXI group than in the WLI group. CONCLUSION Compared to WLI, TXI improved the ADR in patients who underwent chromoendoscopy based on actual clinical data.
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Affiliation(s)
- Osamu Toyoshima
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
| | - Toshihiro Nishizawa
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Takuma Hiramatsu
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Matsuno
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
| | - Shuntaro Yoshida
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Department of Internal Medicine, Yoshida Clinic, Fukaya, Japan
| | - Hiroya Mizutani
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirotoshi Ebinuma
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | | | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Jiang L, Xu F, Feng W, Fu C, Zhou C. The value of hypersensitivity quantitative fecal immunochemical test in early colorectal cancer detection. Postgrad Med J 2024; 100:135-141. [PMID: 38055911 DOI: 10.1093/postmj/qgad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 12/08/2023]
Abstract
At present, both the incidence and mortality rates of colorectal cancer are on the rise, making early screening a crucial tool in reducing the fatality rate. Although colonoscopy is the recommended method according to the guidelines, compliance tends to be poor. The fecal immunochemical test (FIT), a new technology that uses latex immunoturbidimetry to detect fecal blood, offers high specificity and sensitivity. Additionally, it is low-cost, easy to operate, and less likely to be affected by food and drugs, thus improving the compliance rate for population screening. Compared to other screening techniques, FIT represents a safer and more accurate option. This article reviews the application of FIT in early colorectal cancer screening.
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Affiliation(s)
- Lianghong Jiang
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
| | - Fen Xu
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
| | - Weiwei Feng
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
| | - Chen Fu
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
| | - Changjiang Zhou
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
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Gerrard AD, Maeda Y, Miller J, Gunn F, Theodoratou E, Noble C, Porteous L, Glancy S, MacLean P, Pattenden R, Dunlop MG, Din FVN. Double faecal immunochemical testing in patients with symptoms suspicious of colorectal cancer. Br J Surg 2023; 110:471-480. [PMID: 36785496 PMCID: PMC10364540 DOI: 10.1093/bjs/znad016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/31/2022] [Accepted: 01/05/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Faecal immunochemical test (FIT)-directed pathways based on a single test have been implemented for symptomatic patients. However, with a single test, the sensitivity is 87 per cent at 10 µg haemoglobin (Hb) per g faeces. This aims of this study were to define the diagnostic performance of a single FIT, compared with double FIT in symptomatic populations. METHODS Two sequential prospective patient cohorts referred with symptoms from primary care were studied. Patients in cohort 1 were sent a single FIT, and those in cohort 2 received two tests in succession before investigation. All patients were investigated, regardless of having a positive or negative test (threshold 10 µg Hb per g). RESULTS In cohort 1, 2260 patients completed one FIT and investigation. The sensitivity of single FIT was 84.1 (95 per cent c.i. 73.3 to 91.8) per cent for colorectal cancer and 67.4 (61.0 to 73.4) per cent for significant bowel pathology. In cohort 2, 3426 patients completed at least one FIT, and 2637 completed both FITs and investigation. The sensitivity of double FIT was 96.6 (90.4 to 99.3) per cent for colorectal cancer and 83.0 (77.4 to 87.8) per cent for significant bowel pathology. The second FIT resulted in a 50.0 per cent reduction in cancers missed by the first FIT, and 30.0 per cent for significant bowel pathology. Correlation between faecal Hb level was only modest (rs = 0.58), and 16.8 per cent of double tests were discordant, 11.4 per cent in patients with colorectal cancer and 18.3 per cent in those with significant bowel pathology. CONCLUSION FIT in patients with high-risk symptoms twice in succession reduces missed significant colorectal pathology and has an acceptable workload impact.
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Affiliation(s)
- A D Gerrard
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Department of Colorectal surgery, Western General Hospital, Edinburgh, UK
| | - Y Maeda
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Department of Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - J Miller
- Department of Colorectal surgery, Western General Hospital, Edinburgh, UK
| | - F Gunn
- Department of Colorectal surgery, Western General Hospital, Edinburgh, UK
| | - E Theodoratou
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - C Noble
- Department of Gastroenterology, Western General Hospital, Edinburgh, UK
| | - L Porteous
- Lead GP for Cancer and Palliative Care, NHS Lothian, Edinburgh, UK
| | - S Glancy
- Department of Radiology, Western General Hospital, Edinburgh, UK
| | - P MacLean
- Department of Radiology, Western General Hospital, Edinburgh, UK
| | - R Pattenden
- Department of Biochemistry, Western General Hospital, Edinburgh, UK
| | - M G Dunlop
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- UK Colon Cancer Genetics Group, Medical Research Council Human Genetics Unit, Medical Research Council Institute of Genetics & Cancer, Western General Hospital, The University of Edinburgh, Edinburgh, UK
| | - F V N Din
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Department of Colorectal surgery, Western General Hospital, Edinburgh, UK
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One or two faecal immunochemical tests in an organised population-based colorectal cancer screening programme in Murcia (Spain). J Med Screen 2022; 29:231-240. [PMID: 35578555 DOI: 10.1177/09691413221094919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Roll-out of population-based colorectal cancer (CRC) screening with faecal immunochemical test (FIT) is limited by availability of further investigations, particularly colonoscopy and examination of excised lesions. Our objective was to assess whether variation in number of faecal samples and threshold adjustment can optimise resource utilisation and CRC detection rate. METHODS Three different screening strategies were compared for the same FIT threshold using a quantitative FIT system: one FIT, positive when >20 µg Hb/g faeces; two FIT, positive when either was >20 µg Hb/g faeces; and two FIT, positive when the mean was >20 µg Hb/g faeces. We calculated changes in the size of population the provider could invite to screening for an equal number of screening positive results, and CRC and adenoma detected. RESULTS In our setting, Region of Murcia, south of Spain (not fully rolled out screening programme), changing the usual strategy of two FIT, positive when either to positive when the mean was >20 µg Hb/g faeces, would increase population invited by 37.81% with the same number of positive results (which would generate a CRC detection rate of 19.2%). In a fully rolled out programme, changing the strategy from one to two FIT (positive when the mean is >20 µg Hb/g faeces), would increase CRC detection rate by 4.64% with an increase of only 13.34% in positive FIT. CONCLUSIONS In a population-based CRC screening programme, smart use of number of FITs and positivity threshold can increase population invited and CRC detection without increasing the number of colonoscopies and pathological examinations needed.
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Cairns JM, Greenley S, Bamidele O, Weller D. A scoping review of risk-stratified bowel screening: current evidence, future directions. Cancer Causes Control 2022; 33:653-685. [PMID: 35306592 PMCID: PMC8934381 DOI: 10.1007/s10552-022-01568-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 03/02/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE In this scoping review, we examined the international literature on risk-stratified bowel screening to develop recommendations for future research, practice and policy. METHODS Six electronic databases were searched from inception to 18 October 2021: Medline, Embase, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials. Forward and backwards citation searches were also undertaken. All relevant literature were included. RESULTS After de-deduplication, 3,629 records remained. 3,416 were excluded at the title/abstract screening stage. A further 111 were excluded at full-text screening stage. In total, 102 unique studies were included. Results showed that risk-stratified bowel screening programmes can potentially improve diagnostic performance, but there is a lack of information on longer-term outcomes. Risk models do appear to show promise in refining existing risk stratification guidelines but most were not externally validated and less than half achieved good discriminatory power. Risk assessment tools in primary care have the potential for high levels of acceptability and uptake, and therefore, could form an important component of future risk-stratified bowel screening programmes, but sometimes the screening recommendations were not adhered to by the patient or healthcare provider. The review identified important knowledge gaps, most notably in the area of organisation of screening services due to few pilots, and what risk stratification might mean for inequalities. CONCLUSION We recommend that future research focuses on what organisational challenges risk-stratified bowel screening may face and a consideration of inequalities in any changes to organised bowel screening programmes.
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Affiliation(s)
- J M Cairns
- Hull York Medical School, University of Hull, Cottingham Road, Hull, HU6 7HR, UK.
| | - S Greenley
- Hull York Medical School, University of Hull, Cottingham Road, Hull, HU6 7HR, UK
| | - O Bamidele
- Hull York Medical School, University of Hull, Cottingham Road, Hull, HU6 7HR, UK
| | - D Weller
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
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Hunt N, Rao C, Logan R, Chandrabalan V, Oakey J, Ainsworth C, Smith N, Banerjee S, Myers M. A cohort study of duplicate faecal immunochemical testing in patients at risk of colorectal cancer from North-West England. BMJ Open 2022; 12:e059940. [PMID: 35418441 PMCID: PMC9014104 DOI: 10.1136/bmjopen-2021-059940] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES We sought to investigate if duplicate faecal immunochemical testing (FIT) sampling improves the negative and positive predictive value of patients thought to be at risk of colorectal cancer (CRC). Specifically, we aimed to investigate whether the proportion of FIT-negative CRC missed by a single FIT test in symptomatic patients could be reduced by duplicate FIT testing. DESIGN A retrospective service evaluation cohort study of the diagnostic accuracy of duplicate FIT testing. SETTING Patients referred from primary care with suspected CRC to four secondary care trusts in North-West England. PARTICIPANTS 28 622 patients over 18-years-old with lower gastrointestinal symptoms suggestive of CRC who completed two FIT samples. PRIMARY AND SECONDARY OUTCOME MEASURES The performance of duplicate FIT for detecting CRC at a threshold of 10 µgHb/g. RESULTS The sensitivity if either test was >10 µgHb/g was 0.978 (0.955-0.989), specificity was 0.662 (0.657-0.668), positive predictive value 0.031 (0.028-0.035) and negative predictive value 1.00 (0.999-1.00). Despite two-thirds of patients (18952) being negative following two tests, at this threshold only seven CRC were missed over a 26-month period. All seven patients had other high-risk features which should have prompted investigation. CONCLUSIONS This study suggests that in routine NHS practice, a duplicate FIT sample strategy together with clinical evaluation for evidence of anaemia and weight loss is superior to a single FIT sample alone and would allow symptomatic patients to be managed in primary care without the need for urgent referral to secondary care for urgent colonic imaging.
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Affiliation(s)
- Natalie Hunt
- Department of Clinical Biochemistry, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Christopher Rao
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Colorectal Surgery, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
| | - Robert Logan
- Department of Gastroenterology, King's College London, London, UK
| | - Vishnu Chandrabalan
- Department of Colorectal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Jane Oakey
- Clinical Biochemistry, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | | | - Neil Smith
- NHS Blackburn with Darwen CCG, Blackburn, UK
| | | | - Martin Myers
- Department of Clinical Biochemistry, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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