Effect of fecal immunochemical test cut-off levels on adenoma detection rate: a systematic review and meta-analysis

Abstract

Background

Adenoma detection rate (ADR) is higher after a positive fecal immunochemical test (FIT) compared to direct screening colonoscopy.

Objective

This meta-analysis evaluated how ADR, the rates of advanced adenoma detection (AADR), colorectal cancer detection (CDR), and sessile serrated lesion detection (SSLDR) are affected by different FIT positivity thresholds.

Methods

We searched MEDLINE, EMBASE, CINAHL, and EBM Reviews databases for studies reporting ADR, AADR, CDR, and SSLDR according to different FIT cut-off values in asymptomatic average-risk individuals aged 50–74 years old. Data were stratified according to sex, age, time to colonoscopy, publication year, continent, and FIT kit type. Study quality, heterogeneity, and publication bias were assessed.

Results

Overall, 4280 articles were retrieved and fifty-eight studies were included (277,661 FIT-positive colonoscopies; mean cecal intubation 96.3%; mean age 60.8 years; male 52.1%). Mean ADR was 56.1% (95% CI 53.4 − 58.7%), while mean AADR, CDR, and SSLDR were 27.2% (95% CI 24.4 − 30.1%), 5.3% (95% CI 4.7 − 6.0%), and 3.0% (95% CI 1.7 − 4.6%), respectively. For each 20 μg Hb/g increase in FIT cut-off level, ADR increased by 1.54% (95% CI 0.52 − 2.56%, p < 0.01), AADR by 3.90% (95% CI 2.76 − 5.05%, p < 0.01) and CDR by 1.46% (95% CI 0.66 − 2.24%, p < 0.01). Many detection rates were greater amongst males and Europeans.

Conclusions

ADRs in FIT-positive colonoscopies are influenced by the adopted FIT positivity threshold, and identified targets, importantly, proved to be higher than most current societal recommendations.

Keywords:

• Advanced adenoma detection rate
• colorectal cancer detection rate
• sessile serrated lesion detection rate
• colonoscopy
• colorectal cancer

Author contributions

Melissa Zarandi-Nowroozi: study concept and design; acquisition of data; interpretation of data; drafting and revision of the manuscript. Mahsa Taghiakbari: study concept and design; analysis and interpretation of data; revision of the manuscript. Alan Barkun: revision of the manuscript; Heiko Pohl: revision of the manuscript. Bénédicte Nauche: search strategies, revision of the manuscript. Miguel Chagnon: analysis and interpretation of data; and revision of the manuscript. Daniel von Renteln: study concept and design; analysis and interpretation of data; drafting and revision of the manuscript. All authors approved the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Alan Barkun has received consulting honoraria from Olympus. Daniel von Renteln is supported through a Fonds de recherche du Québec Santé (FRQS) career development award, and has received consulting honoraria from Boston Scientific and research support from ERBE, Vantage, and Pentax.