Goals: We analyzed if the predictive value of multitarget stool-based DNA (mt-sDNA) varied when patients had pre-existing known colorectal cancer (CRC) risk factors. Background: mt-sDNA test is approved for CRC screening in average-risk patients. Whether patients with a personal history of adenomatous colon polyps or a family history of CRC (CRC risk factors) benefit from mt-sDNA testing is unknown. Study: We reviewed charts for all positive mt-sDNA referrals between 2017 and 2021. Diagnostic colonoscopy adherence rates were calculated. In those who had colonoscopy, we compared detection rates for any colorectal neoplasia (CRN), multiple (3 or more) adenomas, sessile serrated polyps (SSP), advanced CRN, and CRC between patients with and without known CRC risk factors. Results: Of 1297 referrals for positive mt-sDNA, 1176 (91%) completed a diagnostic colonoscopy. The absence of neoplasia was noted in 27% of colonoscopy exams. When neoplasia was identified, findings were as follows: any CRN (73%), multiple adenomas (34%), SSP (23%), advanced CRN (33%), and CRC (2.5%). One or more CRC risk factors were present in 229 (19%) of cases. In the CRC risk factor subgroup, patients having a prior history of adenomatous polyps or a family history of CRC were no more likely to have any CRN, multiple adenomas, SSP, advanced CRN, or CRC compared to average-risk patients when mt-sDNA was positive. Conclusions: In this real-world analysis of positive mt-sDNA referrals, adherence to subsequent diagnostic colonoscopy recommendations was high. The presence of pre-existing CRC risk factors did not affect the positive predictive value of mt-sDNA.
Purpose: Small intestinal neuroendocrine tumors are the most common type of small bowel malignancy observed. Ileal tumors are often found in patients undergoing ileal intubation during colonoscopy. Our aim was to compare ileal neuroendocrine tumor characteristics when discovered during screening versus diagnostic colonoscopy.Methods: We reviewed all ileal neuroendocrine tumor cases from 2005-2021. We recorded patient age, gender, colonoscopy indication at diagnosis, timing of prior colonoscopy (if ever performed) and whether ileal intubation was performed, tumor size and stage after resection, and disease-free survival.Results: Twenty-eight ileal neuroendocrine tumor cases were diagnosed at colonoscopy. Fifteen patients were having initial screening or surveillance. The remaining 13 were having diagnostic evaluation of symptoms, abnormal CT imaging, or abnormal stool test results. A prior colonoscopy was performed within the preceding 10-year period in 14 cases, and of these, 8 did not include terminal ileum intubation. Tumor size ranged from 0.5 to 3.7 cm and mean size was nearly identical in screening and diagnostic groups (1.7 vs 1.9 cm). Lymph nodes were involved in 25 of 28 patients. At diagnosis, 2 patients had distant metastases. Mean survival-to-date was similar for both groups as well (85 vs 88 months).Conclusion: Nearly all ileal neuroendocrine tumors discovered during colonoscopy were associated with nodal metastasis at the time of diagnosis. Most, however, have enjoyed prolonged survival. No signi cant difference in tumor size, stage, or survival was observed between patients having screening versus diagnostic colonoscopy. Our ndings support performing routine ileal intubation during colonoscopy for all indications.
Purpose: Small intestinal neuroendocrine tumors are the most common type of small bowel malignancy observed. Ileal tumors are often found in patients undergoing ileal intubation during colonoscopy. Our aim was to compare ileal neuroendocrine tumor characteristics when discovered during screening versus diagnostic colonoscopy. Methods: We reviewed all ileal neuroendocrine tumor cases from 2005-2021. We recorded patient age, gender, colonoscopy indication at diagnosis, timing of prior colonoscopy (if ever performed) and whether ileal intubation was performed, tumor size and stage after resection, and disease-free survival. Results: Twenty-eight ileal neuroendocrine tumor cases were diagnosed at colonoscopy. Fifteen patients were having initial screening or surveillance. The remaining 13 were having diagnostic evaluation of symptoms, abnormal CT imaging, or abnormal stool test results. A prior colonoscopy was performed within the preceding 10-year period in 14 cases, and of these, 8 did not include terminal ileum intubation. Tumor size ranged from 0.5 to 3.7 cm and mean size was nearly identical in screening and diagnostic groups (1.7 vs 1.9 cm). Lymph nodes were involved in 25 of 28 patients. At diagnosis, 2 patients had distant metastases. Mean survival-to-date was similar for both groups as well (85 vs 88 months). Conclusion: Nearly all ileal neuroendocrine tumors discovered during colonoscopy were associated with nodal metastasis at the time of diagnosis. Most, however, have enjoyed prolonged survival. No significant difference in tumor size, stage, or survival was observed between patients having screening versus diagnostic colonoscopy. Our findings support performing routine ileal intubation during colonoscopy for all indications.
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