Prediction of advanced colonic neoplasm in symptomatic patients: a scoring system to prioritize colonoscopy (COLONOFIT study)
BackgroundFast-track colonoscopy to detect patients with colorectal cancer based on high-risk symptoms is associated with low sensitivity and specificity. The aim was to derive a predictive score of advanced colonic neoplasia in symptomatic patients in fast-track programs.MethodsAll patients referre...
| Authors: | , , , , , , , , , , , , |
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| Format: | article |
| Status: | Published version |
| Publication Date: | 2019 |
| Country: | España |
| Institution: | Institut d'Investigació i Innovació Parc Taulí (I3PT) |
| Repository: | r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí |
| OAI Identifier: | oai:i3pt.fundanetsuite.com:p3640 |
| Online Access: | https://i3pt.portalinvestigacion.com/publicaciones/3640 |
| Access Level: | Open access |
| Keyword: | Colorectal cancer Advanced adenoma Faecal immunological occult haemoglobin test Fast-track colonoscopy |
| Summary: | BackgroundFast-track colonoscopy to detect patients with colorectal cancer based on high-risk symptoms is associated with low sensitivity and specificity. The aim was to derive a predictive score of advanced colonic neoplasia in symptomatic patients in fast-track programs.MethodsAll patients referred for fast-track colonoscopy were evaluated. Faecal immunological haemoglobin test (3 samples; positive>4 mu g Hb/g), and a survey to register clinical variables of interest were performed. Colorectal cancer and advanced adenoma were considered as advanced colonic neoplasia. A sample size of 600 and 500 individuals were calculated for each phase 1 and phase 2 of the study, respectively (Phase 1, derivation and Phase 2, validation cohort). A Bayesian logistic regression analysis was used to derive a predictive score.Results1495 patients were included. Age (OR, 21), maximum faecal-Hb value (OR, 2.3), and number of positive samples (OR, 28) presented the highest ORs predictive of advanced colonic neoplasia. The additional significant predictive variables adjusted for age and faecal-Hb variables in Phase 1 were previous colonoscopy (last 5years) and smoking (no, ex/active). With these variables a predictive score of advanced colonic neoplasia was derived. Applied to Phase 2, patients with a Score>20 had an advanced colonic neoplasia probability of 66% (colorectal cancer, 32%), while those with a Score <= 10, a probability of 10% (colorectal cancer, 1%). Prioritizing patients with Score>10, 49.4% of patients would be referred for fast-track colonoscopy, diagnosing 98.3% of colorectal cancers and 77% of advanced adenomas.ConclusionsA scoring system was derived and validated to prioritize fast-track colonoscopies according to risk, which was efficient, simple, and robust. |
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