2839 Outcomes of a Positive Cologuard Test in an Outpatient Internal Medicine Practice

Abstract

INTRODUCTION: In the United States, colorectal cancer (CRC) is the second leading cause of death. Colonoscopy and fecal immunochemical test (FIT) are recommended as first tier tests for colorectal cancer screening. Cologuard is an attractive and effective modality of screening in patients apprehensive of undergoing a colonoscopy with a sensitivity and specificity of upto 90%. We performed a retrospective chart review to assess the outcomes of cologuard testing and subsequent colonoscopy results in an outpatient population. METHODS: A total of 550 patients underwent cologuard testing in our outpatient internal medicine practice. We performed a retrospective chart review to identify patient characteristics in patients with a positive cologuard test and correlate them with colonoscopy findings. Primary outcome was to identify colonoscopy findings in patients with a positive cologuard test. Secondary outcome was to identify patient characteristics in this patient population. RESULTS: 52 of these patients (9.45%) had a positive cologuard test. The average age of these patients was 68 years. 222 of these were males and 328 females. Most of them were non-hispanic or non-latino whites (39), with two hispanics, and one American Indian. Nine patients refused to report their ethnicity. All of these patients were referred to gastroenterology for a screening colonoscopy. Out of the 52 patients that were referred, 34 (65.38%) underwent a screening colonoscopy. Four patients were lost to follow-up, eight patients could not undergo a screening colonoscopy secondary to significant medical co-morbidities and six declined the colonoscopy. 29 (85.29%) patients had an abnormal colonoscopy with significant findings. Five patients had a normal colonoscopy with no remarkable findings. The total number of polyps found in these patients was 70, ranging from one polyp seen in nine patients to 12 polyps seen in one patient. The most common location for a polyp was the sigmoid colon followed by the transverse colon, with fewest polyps seen in the cecum. The most common histological diagnosis was hyperplastic, followed by sessile serrated and villous adenomas. CONCLUSION: We noted a high degree of correlation between a positive cologuard test and the presence of colonic polyps. Cologuard is an effective and convenient non-invasive screening modality in patients that do not wish to undergo a colonoscopy. Appropriate follow-up and referral to gastroenterology is essential for patients with a positive cologuard test.