FIT-Fecal DNA Test Had High Positive Predictive Value in Second-Round Screening

Douglas K. Rex, MD, MASGE, reviewing Voss JK, et al. Clin Gastroenterol Hepatol 2023 Jan 5.

This study examined the positive predictive value (PPV) of a second round of screening with a fecal immunochemical test (FIT)-fecal DNA test (Cologuard, Exact Sciences). The study included 2758 patients who had a negative baseline test at a median of 3.2 years earlier. Fifty-eight percent had a colonoscopy at a median of 10.4 years before their first FIT-fecal DNA test, but only 1.1% of those patients had a prior low-risk adenoma. 

The overall positivity rate in the second round of screening was 15.3%. The PPV was 0.25% for colorectal cancer (CRC), 24% for advanced lesions (advanced adenomas, sessile serrated lesions [SSLs] ≥1 cm, or SSLs with dysplasia), and 67% for any colorectal neoplasia.

In comparison, PPVs in first-round screening in another cohort were 1% for CRC and 28% for advanced lesions.

Douglas K. Rex, MD, FASGE

COMMENT

These data indicate that a second round of screening with a FIT-fecal DNA test can be expected to produce a similar positivity rate, a lower yield of CRC, and a similar yield of advanced lesions as those for first-round screening. Clearly, patients with positive tests in the second round should undergo colonoscopy.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Voss JK, Ebner DW, Burger KN, et al. Multitarget stool DNA testing has high positive predictive value for colorectal neoplasia on the second round of testing. Clin Gastroenterol Hepatol 2023 Jan 5. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2022.12.026)

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