• Am. J. Gastroenterol. · Apr 2020

    Multicenter Study

    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, and John B Kisiel.
    • Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
    • Am. J. Gastroenterol. 2020 Apr 1; 115 (4): 608-615.

    ObjectivesMultitarget 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.MethodsWe 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.ResultsOf 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.DiscussionMT-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.

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