Prediction of advanced colonic neoplasm in symptomatic patients: a scoring system to prioritize colonoscopy (COLONOFIT study)

• Published in: BMC cancer Vol. 19; no. 1; p. 734
• Main Authors: Fernández-Bañares, Fernando, Clèries, Ramon, Boadas, Jaume, Ribes, Josepa, Oliva, Joan Carles, Alsius, Antoni, Sanz, Xavier, Martínez-Bauer, Eva, Galter, Sara, Pujals, Mar, Pujol, Marta, Del Pozo, Patricia, Campo, Rafel
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 25.07.2019; BioMed Central; BMC
• Subjects: Adenoma; Adenoma - diagnosis; Adult; Advanced adenoma; Cancer; Cancer patients; Cancer screening; Colonic Neoplasms - diagnosis; Colonoscopy; Colonoscopy - standards; Colorectal cancer; Diagnosis; Early Detection of Cancer - methods; Early Detection of Cancer - standards; Faecal immunological occult haemoglobin test; Fast-track colonoscopy; Female; Hemoglobins; Humans; Male; Mass Screening - methods; Mass Screening - standards; Methods; Middle Aged; Models, Biological; Occult Blood; Patient Selection; Practice Guidelines as Topic; Predictive Value of Tests; Prognosis; Prospective Studies; Regression analysis; Risk Assessment - methods; Risk Factors; Sensitivity and Specificity; Time Factors; Tumors; Spain; Faecal immunological occult haemoglobin test; Advanced adenoma; Colorectal cancer; Fast-track colonoscopy
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-019-5926-4

Fast-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. All patients referred for fast-track colonoscopy were evaluated. Faecal immunological haemoglobin test (3 samples; positive> 4 μg 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. 1495 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 5 years) 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. A scoring system was derived and validated to prioritize fast-track colonoscopies according to risk, which was efficient, simple, and robust.