Higher risk of advanced histology in adenoma less than 10 mm in fecal immunochemical test screening: Implication for management
Journal
Journal of Gastroenterology and Hepatology (Australia)
Journal Volume
35
Journal Issue
10
Pages
1738-1745
Date Issued
2020
Abstract
Background and Aim: Whether diminutive or small adenomas detected by fecal immunochemical tests (FITs) are associated with a higher risk of advanced histology remains unknown. We investigated the prevalence of advanced histology in diminutive and small adenomas detected by FIT and compared with that detected by colonoscopy screening. Methods: We prospectively compared 1860 FIT-positive patients (FIT-positive cohort) and 6691 average-risk patients (screening colonoscopy cohort). Both groups underwent colonoscopies and were shown to have neoplastic lesions. The prevalence of advanced histology was determined, as was the associations with size and FIT positivity. Results: We analyzed 3920 neoplastic lesions from the FIT-positive cohort and 9789 neoplastic lesions from the screening colonoscopy cohort. Eighty (4.3%) diminutive lesions in FIT-positive cohort had advanced histology but without any invasive cancer. Twenty-one patients in the FIT-positive cohort and 49 in the screening colonoscopy cohort with diminutive adenomas displayed advanced histology (3.5% vs 1.2%; adjusted odds ratio [aOR]?=?2.99, 95% confidence interval [CI]: 1.77–5.06). Sixteen patients in the FIT-positive cohort (2.7%) with diminutive adenomas might have changed the surveillance interval if a resect-and-discard strategy was applied, with a higher likelihood compared with the screening colonoscopy cohort (aOR?=?2.76, 95% CI: 1.53–4.99). Conclusions: Fecal immunochemical test screening detected more diminutive and small adenomas with advanced histology compared with colonoscopy screening. Its impact on current management of diminutive polyp is limited. ? 2020 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd
SDGs
Other Subjects
adult; advanced cancer; Article; cancer screening; cohort analysis; colonoscopy; colorectal adenoma; colorectal carcinoma; colorectal surgery; controlled study; disease surveillance; female; histopathology; human; human tissue; major clinical study; male; middle aged; occult blood test; priority journal; prospective study; adenoma; aged; chemistry; colon tumor; comparative study; early cancer diagnosis; feces; immunochemistry; mass screening; pathology; prevalence; procedures; Adenoma; Aged; Cohort Studies; Colonic Neoplasms; Early Detection of Cancer; Feces; Female; Humans; Immunochemistry; Male; Mass Screening; Middle Aged; Prevalence; Prospective Studies
Publisher
Blackwell Publishing
Type
journal article