lunes, 9 de noviembre de 2015

Stool DNA Testing for Screening Detection of Colorectal Neoplasia in Alaska Native People. - PubMed - NCBI

2015 Oct 28. pii: S0025-6196(15)00803-4. doi: 10.1016/j.mayocp.2015.10.008. [Epub ahead of print]

Stool DNA Testing for Screening Detection of Colorectal Neoplasia in Alaska Native People.

Redwood DG1, Asay ED2, Blake ID2, Sacco PE2, Christensen CM2, Sacco FD3, Tiesinga JJ4, Devens ME5, Alberts SR6, Mahoney DW7, Yab TC5, Foote PH5,Smyrk TC8, Provost EM2, Ahlquist DA5.

Author information

Abstract

OBJECTIVE:

To assess the accuracy of a multitarget stool DNA test (MT-sDNA) compared with fecal immunochemical testing for hemoglobin (FIT) for detection of screening-relevant colorectal neoplasia (SRN) in Alaska Native people, who have among the world's highest rates of colorectal cancer (CRC) and limited access to conventional screening approaches.

PATIENTS AND METHODS:

We performed a prospective, cross-sectional study of asymptomatic Alaska Native adults aged 40-85 years and older undergoing screening or surveillance colonoscopy between February 6, 2012, and August 7, 2014.

RESULTS:

Among 868 enrolled participants, 661 completed the study (403 [61%] women). Overall, SRN detection by MT-sDNA (49%) was superior to that by FIT (28%; P<.001); in the screening group, SRN detection rates were 50% and 31%, respectively (P=.01). Multitarget stool DNA testing detected 62% of adenomas 2 cm or larger vs 29% by FIT (P=.05). Sensitivity by MT-sDNA increased with adenoma size (to 80% for lesions ≥3 cm; P=.01 for trend) and substantially exceeded FIT sensitivity at all adenoma sizes. For sessile serrated polyps larger than 1 cm (n=9), detection was 67% by MT-sDNA vs 11% by FIT (P=.07). For CRC (n=10), detection was 100% by MT-sDNA vs 80% by FIT (P=.48). Specificities were 93% and 96%, respectively (P=.03).

CONCLUSION:

The sensitivity of MT-sDNA for cancer and larger polyps was high and significantly greater than that of FIT for polyps of any size, while specificity was slightly higher with FIT. These findings could translate into high cumulative neoplasm detection rates on serial testing within a screening program. The MT-sDNA represents a potential strategy to expand CRC screening and reduce CRC incidence and mortality, especially where access to endoscopy is limited.