Detection Rate of Colorectal Cancer or Precancer Adenoma by Colonoscopy After 1, 2, or 3 Positive Results via Fecal Immunochemical Testing.

Abstract

Background\nSingle-vial fecal immunochemical testing (FIT) is an accepted method of colorectal cancer (CRC) screening. The available 3-vial FIT data set allows for comparison of colonoscopy results using various screening methods.\n\n\nObjective\nTo determine the optimal number of vials for a strong FIT-screening program by examining whether using only a single vial impacts the use of colonoscopy for CRC screening.\n\n\nMethods\nPatients were given 3-vial FIT collection kits that were processed with a positive hemoglobin cut-off detection level of 100 ng per mL. If FIT results were positive, colonoscopy testing was performed using standard practices.\n\n\nResults\nDetection of CRC and precursor adenoma was examined in 932 patients, with a positive colonoscopy sensitivity of 56.2% and 3.0% CRC detection after 3-vial FIT; after single-vial screening, those values were 60.9% and 4.7%, respectively.\n\n\nConclusions\nPrescreening patients with FIT testing before colonoscopy allows colonoscopy testing to be targeted to higher-risk patients. Implementing use of only a single vial from the 3-vial FIT screening kit would reduce the colonoscopy reflex rate, colonoscopy complication numbers, facility costs, and patient distress by more than 40%, compared with 3-vial screening.