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Multicenter Study
. 2020 Apr;115(4):608-615.
doi: 10.14309/ajg.0000000000000546.

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

Jason D Eckmann  1 , Derek W Ebner  1 , Jamie Bering  2 , Allon Kahn  3 , Eduardo Rodriguez  3 , Mary E Devens  4 , Kari L Lowrie  4 , Karen Doering  4 , Sara Then  4 , Kelli N Burger  5 , Douglas W Mahoney  5 , David O Prichard  4   6 , Michael B Wallace  7 , Suryakanth R Gurudu  3 , Lila J Finney  8 , Paul Limburg  4 , Barry Berger  4   9 , David A Ahlquist  4 , John B Kisiel  4
Affiliations
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 et al. Am J Gastroenterol. 2020 Apr.

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.

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Figures

Figure 1.
Figure 1.
Study flow diagram. CRC, colorectal cancer; MT-sDNA, multitarget stool DNA.
Figure 2.
Figure 2.
(a) Yield of neoplastic findings at diagnostic colonoscopy for all patients with MT-sDNA-positive tests. (b) Proportion of neoplastic lesions among patients with colorectal neoplasia at diagnostic colonoscopy after positive MT-sDNA test, stratified by exposure to previous screening colonoscopy. CRN, colorectal neoplasia; MT-sDNA, multitarget stool DNA.
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