Stool-Based Tests Equal, mt-sDNA Finds More Serrated Lesions

TOPLINE:

Stool-based tests for colorectal cancer (CRC) screening show no significant difference in detecting advanced neoplasia overall, but for advanced serrated lesions specifically, the multitarget stool DNA (mt-sDNA) test outperforms the other tests.

METHODOLOGY:

• Selecting the most appropriate stool-based test for recommended CRC screening for average-risk individuals is challenging.
• Researchers conducted a retrospective review to assess the real-world performance of the mt-sDNA test, fecal immunochemical test (FIT), and fecal occult blood test (FOBT) for CRC screening in average-risk individuals at Duke Primary Care, Durham, North Carolina, between 2017 and 2019.
• They included 302 individuals (mean age, 63 years; 59.27% women) who met the “average risk” criteria and had documented follow-up colonoscopy within 12 months of a positive stool-based test.
• The primary outcome was the presence of advanced neoplasia, defined as adenocarcinoma, advanced adenomas, and/or advanced serrated lesions at the follow-up colonoscopy.

TAKEAWAY:

• No significant difference was found between the three types of stool-based tests for the detection of advanced neoplasia overall.
• However, the mt-sDNA test showed a significantly higher detection rate for advanced serrated lesions than FIT and FOBT (11.3% vs 1.8% and 0%, respectively; P < .001).
• A sensitivity analysis evaluating outcomes specifically for advanced serrated lesions with hyperplastic polyps sized 5-9 mm also found that mt-sDNA had a higher detection rate than FIT and FOBT (17.7% vs 4.4% and 0%, respectively; P < .001).
• The positive predictive value for advanced neoplasia was the highest for the mt-sDNA test (30.7%), followed by FIT (22.8%) and FOBT (18.8%), but the confidence intervals for the mt-sDNA test and FIT overlapped slightly.

IN PRACTICE:

“Our study provided real-world evidence in a large, opportunistic screening program and showed that while there was no significant difference between SBTs [stool-based tests] in the detection of advanced neoplasia, more advanced serrated lesions were detected after positive mt-sDNA compared with other SBTs,” the authors wrote.

SOURCE:

This study, led by Catherine Cheney, MD, Department of Medicine, Duke University Medical Center, Duke University, Durham, North Carolina, was published online in the Journal of Clinical Gastroenterology.

LIMITATIONS:

The retrospective nature of the study limited the ability to assess the follow-up outcomes in individuals with negative stool-based tests or no follow-up colonoscopy after a positive stool-based test. The study population was small and largely comprised insured individuals. The researchers could not systematically assess the use or outcomes of noninvasive stool testing for off-label purposes, such as screening in patients with above-average risk.

DISCLOSURES:

This study was funded by Exact Sciences. One author received support from the American Gastroenterological Association Research Foundation and reported consulting work for Exact Sciences outside this study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.