Abstract
Background
There is uncertainty as to the appropriate follow-up of patients who test positive on multimarker stool DNA (sDNA) testing and have a colonoscopy without neoplasia.
Aims
To determine the prevalence of missed colonic or occult upper gastrointestinal neoplasia in patients with an apparent false positive sDNA.
Methods
We prospectively identified 30 patients who tested positive with a commercially available sDNA followed by colonoscopy without neoplastic lesions. Patients were invited to undergo repeat sDNA at 11–29 months after the initial test followed by repeat colonoscopy and upper endoscopy. We determined the presence of neoplastic lesions on repeat evaluation stratified by results of repeat sDNA.
Results
Twelve patients were restudied. Seven patients had a negative second sDNA test and a normal second colonoscopy and upper endoscopy. In contrast, 5 of 12 subjects had a persistently positive second sDNA test, and 3 had positive findings, including a 3-cm sessile transverse colon adenoma with high-grade dysplasia, a 2-cm right colon sessile serrated adenoma with dysplasia, and a nonadvanced colon adenoma (p = 0.045). These corresponded to a positive predictive value of 0.60 (95% CI 0.17–1.00) and a negative predictive value of 1.00 (95% CI 1.00–1.00) for the second sDNA test. In addition, the medical records of all 30 subjects with apparent false positive testing were reviewed and no documented cases of malignant tumors were recorded.
Conclusions
Repeat positive sDNA testing may identify a subset of patients with missed or occult colorectal neoplasia after negative colonoscopy for an initially positive sDNA. High-quality colonoscopy with careful attention to the right colon in patients with positive sDNA is critically important and may avoid false negative colonoscopy.
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Acknowledgments
This work was supported by the Case Gastrointestinal SPORE (P50CA150964), the Case Comprehensive Cancer Center (P30CA43703), the Cleveland Digestive Disease Research Core Center (P30DK097948), University of Michigan Gastrointestinal SPORE (P50CA130810), the University of Michigan Comprehensive Cancer Center (P30CA046592), the Early Detection Research Network (U01CA086400) and U01CA181770.
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Conflict of interest
Barry M. Berger, MD, is a full-time employee of Exact Sciences, Inc, the manufacturer of the stool DNA technology used in this study. None of the other authors have conflicts of interest.
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Cooper, G.S., Markowitz, S.D., Chen, Z. et al. Evaluation of Patients with an Apparent False Positive Stool DNA Test: The Role of Repeat Stool DNA Testing. Dig Dis Sci 63, 1449–1453 (2018). https://doi.org/10.1007/s10620-018-5001-z
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DOI: https://doi.org/10.1007/s10620-018-5001-z