Multitarget Stool DNA Screening in Clinical Practice: High Positive Predictive Value for Colorectal Neoplasia Regardless of Exposure to Previous Colonoscopy

Jason D. Eckmann, Derek W. Ebner, Jamie Bering, Allon Kahn, Eduardo Rodriguez, Mary E. Devens, Kari L. Lowrie, Karen Doering, Sara Then, Kelli N. Burger, Douglas W. Mahoney, David O. Prichard, Michael B. Wallace, Suryakanth R. Gurudu, Lila J. Finney, Paul Limburg, Barry Berger, David A. Ahlquist, John B. Kisiel

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

OBJECTIVES:Multitarget stool DNA (MT-sDNA) testing has grown as a noninvasive screening modality for colorectal cancer (CRC), but real-world clinical data are limited in the post-FDA approval setting. The effect of previous colonoscopy on MT-sDNA performance is not known. We aimed to evaluate findings of colorectal neoplasia (CRN) at diagnostic colonoscopy in patients with positive MT-sDNA testing, stratified by patient exposure to previous colonoscopy.METHODS:We identified consecutive patients completing MT-sDNA testing over a 39-month period and reviewed the records of those with positive tests for neoplastic findings at diagnostic colonoscopy. MT-sDNA test positivity rate, adherence to diagnostic colonoscopy, and the positive predictive value (PPV) of MT-sDNA for any CRN and neoplastic subtypes were calculated.RESULTS:Of 16,469 MT-sDNA tests completed, testing returned positive in 2,326 (14.1%) patients. After exclusion of patients at increased risk for CRC, 1,801 patients remained, 1,558 (87%) of whom underwent diagnostic colonoscopy; 918 of 1,558 (59%) of these patients had undergone previous colonoscopy, whereas 640 (41%) had not. Any CRN was found in 1,046 of 1,558 patients (PPV = 67%). More neoplastic lesions were found in patients without previous colonoscopy (73%); however, the rates remained high among those who had undergone previous colonoscopy (63%, P < 0.0001). The large majority (79%) of patients had right-sided neoplasia.DISCUSSION:MT-sDNA has a high PPV for any CRN regardless of exposure to previous colonoscopy. Right-sided CRN was found at colonoscopy in most patients with positive MT-sDNA testing, representing a potential advantage over other currently available screening modalities for CRC.

Original languageEnglish (US)
Pages (from-to)608-615
Number of pages8
JournalAmerican Journal of Gastroenterology
Volume115
Issue number4
DOIs
StatePublished - Apr 1 2020

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Eckmann, J. D., Ebner, D. W., Bering, J., Kahn, A., Rodriguez, E., Devens, M. E., Lowrie, K. L., Doering, K., Then, S., Burger, K. N., Mahoney, D. W., Prichard, D. O., Wallace, M. B., Gurudu, S. R., Finney, L. J., Limburg, P., Berger, B., Ahlquist, D. A., & Kisiel, J. B. (2020). Multitarget Stool DNA Screening in Clinical Practice: High Positive Predictive Value for Colorectal Neoplasia Regardless of Exposure to Previous Colonoscopy. American Journal of Gastroenterology, 115(4), 608-615. https://doi.org/10.14309/ajg.0000000000000546