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Positive Fecal Immunochemical Test and Negative Colonoscopy: Should Upper Endoscopy Be Next?
In a patient undergoing colorectal cancer (CRC) screening, how often does a positive fecal immunochemical test (FIT) followed by a negative colonoscopy suggest a cancer proximal to the colon? To address this issue, Dutch researchers used data from a CRC screening registry that included about 2 million middle-aged patients (age range, 55–75) who were screened with quantitative FIT tests (threshold for positivity, 47 µg hemoglobin/g of feces).
Findings were as follows:
- About 3% of patients were FIT-positive with negative colonoscopy, 3% were FIT-positive with advanced neoplasia (advanced adenoma or colorectal cancer), and 94% were FIT-negative.
- The 3-year incidence of cancers proximal to the colon was slightly (but statistically significantly) higher in FIT-positive than in FIT-negative patients (≈0.6% vs. 0.4%).
- The 3-year incidence of cancers potentially detectable by esophagogastroduodenoscopy (EGD) also was higher in FIT-positive patients than in FIT-negative patients (0.4% vs. 0.2%).
- Among FIT-positive patients, incidence of cancers proximal to the colon was similar in patients with or without advanced colorectal neoplasia.
Comment
The incidence of cancer proximal to the colon was very low in these FIT-positive patients in the Netherlands. Because ≈250 FIT-positive patients would have to undergo EGD to detect 1 cancer, the authors conclude (and we agree) that EGD generally isn't warranted unless the patient has upper gastrointestinal symptoms or systemic cancer-related symptoms. However, the authors acknowledge that this conclusion might not apply to patient populations with higher background risk for gastric cancer.
Citation(s)
Author:
de Klaver W et al.
Title:
Risk of cancers proximal to the colon in fecal immunochemical test positive screenees in a colorectal cancer screening program.
Source:
Gastroenterology
2024
Sep
; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
David S. Weisman, DO, FACP
Empfohlen von
Allan S. Brett, MD