A Comparison of Single and Combined Schemes of Asia-Pacific Colorectal Screening, Faecal Immunochemical and Stool Deoxyribonucleic Acid Testing for Community Colorectal Cancer Screening

Abstract

Objective To compare the screening efficacy of colonoscopy and pathologically confirmed single and combined Asia-Pacific colorectal screening (APCS), faecal immunochemical testing (FIT) and stool deoxyribonucleic acid (sDNA) testing protocols. Methods From April 2021 to April 2022, 842 volunteers participated in primary colorectal cancer (CRC) screenings using APCS scoring, FIT and sDNA testing and 115 underwent a colonoscopy. One hundred high-risk participants were then identified from the results of both processes. The differences in the three CRC screening tests in combination with the colonoscopy pathology diagnostics were evaluated using Cochran’s Q test, the Dunn–Bonferroni test and area under the receiver operating characteristic curve (AUC) value analysis. Results Both FIT and sDNA testing demonstrated a 100% performance in detecting CRC. For advanced adenoma, the sensitivity of the FIT + sDNA test scheme (double positive) was 29.2%, and the sensitivities of the combined FIT + sDNA test and APCS scoring + sDNA test schemes were 62.5% and 95.8%, respectively. The FIT + sDNA testing kappa value of advanced colorectal neoplasia was 0.344 ( p = 0.011). The sensitivity for nonadvanced adenoma of the APCS score + sDNA test scheme was 91.1%. In terms of positive results, the sensitivity of the APCS score + FIT + sDNA detection protocol was significantly higher than that of the APCS score, FIT, sDNA detection, and FIT + sDNA detection methods (adjusted p < 0.001, respectively). For the FIT + sDNA test, the kappa value was 0.220 ( p = 0.015) and the AUC was 0.634 ( p = 0.037). The specificity of the FIT + sDNA test scheme was 69.0%. Conclusion The FIT + sDNA test scheme demonstrated superior diagnostic efficacy, and the combined APCS score + FIT + sDNA test scheme demonstrated remarkable improvements in CRC screening efficiency and sensitivity for detecting positive lesions.

Developing a Nomogram for Predicting Colorectal Cancer and Its Precancerous Lesions Based on Data from Three Non-Invasive Screening Tools, APCS, FIT, and sDNA

“…In a previous study, the combination of FIT and sDNA tests obtained a sensitivity of about 50.00% for precancerous lesions. 6 In the present study, most of the positive cases we enrolled were LGIN. We found that the AUC of our prediction model for predicting positive colonoscopy results was much higher than that of the FIT + sDNA test scheme.…”

“…In our previous study, sDNA test using methylated SDC2 exhibited better sensitivity than FIT for detecting LGIN, AA and advanced colorectal neoplasia. 6 …”

“…Aniwan et al 11 reported that high APCS scores with positive FIT results had a significantly higher detection rate of advanced neoplasia. Furthermore, our previous study 6 found that the combined use of the 3 methods of APCS score, FIT and sDNA test demonstrated remarkable improvements in CRC screening efficiency and sensitivity for detecting positive lesions. Thus, the combination of APCS score, FIT and sDNA test is a potential non-invasive strategy for CRC and precancerous lesions screening.…”

“… 8 However, the specificity of APCS score in CRC screening is very low; thus, other non-invasive strategies are suggested to combine with APCS score in order to improve the diagnostic accuracy. 6 FIT is highly sensitive in detecting blood hemoglobin in the fecal lower digestive tract. It has become a preferred method for CRC screening.…”

“…However, it also has many disadvantages, such as invasiveness, high cost and patient discomfort, which limit its clinical use. 6 The non-invasive screening strategies, including Asia-Pacific colorectal screening (APCS) scoring, fecal immunochemical testing (FIT), stool deoxyribonucleic acid (sDNA) test, CT colonography and blood-based tests, are more convenient and available for CRC screening. 5 APCS score is a well validated scoring system with an aim to assess the risk of CRC in Asian populations.…”