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Neoplasia Diagnosis After Multi-target Stool DNA Is Enhanced Among Lowest Baseline Detectors

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Abstract

Background and Aims

Variation in colorectal neoplasia detection limits the effectiveness of screening colonoscopy. By evaluating neoplasia detection rates of individual colonoscopists, we aimed to quantify the effects of pre-procedural knowledge of a positive (+) multi-target stool DNA (mt-sDNA) on colonoscopy quality metrics.

Methods

We retrospectively identified physicians who performed a high volume of + mt-sDNA colonoscopies; colorectal neoplasia at post-mt-sDNA colonoscopy was recorded. These colonoscopists were stratified into quartiles based on baseline adenoma detection rates. Baseline colonoscopy adenoma detection rates and sessile serrated lesion detection rates were compared to post-mt-sDNA colonoscopy neoplasia diagnosis rates among each quartile. Withdrawal times were measured from negative exams.

Results

During the study period (2014–17) the highest quartile of physicians by volume of post-mt-sDNA colonoscopies were evaluated. Among thirty-five gastroenterologists, their median screening colonoscopy adenoma detection rate was 32% (IQR, 28–39%) and serrated lesion detection rate was 13% (8–15%). After + mt-sDNA, adenoma diagnosis increased to 47% (36–56%) and serrated lesion diagnosis increased to 31% (17–42%) (both p < 0.0001). Median withdrawal time increased from 10 (7–13) to 12 (10–17) minutes (p < 0.0001) and was proportionate across quartiles. After + mt-sDNA, lower baseline detectors had disproportionately higher rates of adenoma diagnosis in female versus male patients (p = 0.048) and higher serrated neoplasia diagnosis rates among all patients (p = 0.0092).

Conclusions

Knowledge of + mt-sDNA enriches neoplasia diagnosis compared to average risk screening exams. Adenomatous and serrated lesion diagnosis was magnified among those with lower adenoma detection rates. Awareness of the mt-sDNA result may increase physician attention during colonoscopy.

Graphical Abstract

Pre-procedure knowledge of a positive mt-sDNA test improves neoplasia diagnosis rates among colonoscopists with lower baseline adenoma detection rates, independent of withdrawal time.

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Abbreviations

CRN:

Colorectal neoplasia

mt-sDNA:

Multi-target stool DNA

ADR:

Adenoma detection rate

SDR:

Serrated lesion detection rate

CRC:

Colorectal cancer

SSL:

Sessile serrated lesion

IQR:

Interquartile range

CI:

Confidence intervals

FIT:

Fecal immunochemical test

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Funding

This work was supported by a grant from the National Institutes of Health (CA214679, to Kisiel).

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Authors and Affiliations

  1. Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Derek W. Ebner, Kelli N. Burger, Douglas W. Mahoney, Brendan T. Broderick, Mary E. Devens, Kari L. Lowrie, John B. League, David O. Prichard, Sunanda V. Kane, Navtej S. Buttar, Lila J. Finney Rutten & John B. Kisiel

  2. Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA

    Jason D. Eckmann

  3. Mayo Clinic, Scottsdale, AZ, USA

    Jamie Bering, Allon Kahn, Jonathan A. Leighton & Suryakanth R. Gurudu

  4. Division of Gastroenterology, Hepatology and Nutrition, University of Utah, Salt Lake City, UT, USA

    Eduardo A. Rodriguez

  5. Mayo Clinic, Jacksonville, FL, USA

    Michael B. Wallace

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Contributions

DWE: Data curation, investigation, writing of original draft, lead. KNB: Data curation, formal analysis, project administration, writing- review and editing, supporting. DWM: Data curation, formal analysis, methodology, validation, writing-review and editing, supporting. BTB: Data curation, formal analysis, writing-review and editing, supporting. JDE: Data curation, writing-review and editing, supporting. MED: Data curation, writing-review and editing, supporting. KLL: Data curation, writing-review and editing, supporting. JBL: Data curation, methodology, writing-review and editing, supporting. JB: Data curation, writing-review and editing, supporting. AK: Data curation, writing-review and editing, supporting. EAR: Data curation, writing-review and editing, supporting. DOP: Methodology, writing-review and editing, supporting. MBW: Methodology, writing-review and editing, supporting. SVK: Methodology, writing-review and editing, supporting. JAL: Methodology, writing-review and editing, supporting. NSB: Methodology, writing-review and editing, supporting. LJFR: Methodology, writing-review and editing, supporting. SRG: Methodology, writing-review and editing, supporting. JBK: Conceptualization, funding acquisition, methodology, lead, writing-review and editing, supporting.

Corresponding author

Correspondence to John B. Kisiel.

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Conflicts of interest

Dr. Ebner has a professional service agreement with Exact Sciences (Madison, WI) serving as an independent contractor to provide guidance on study design and analysis. Dr. Kisiel and Mr. Mahoney are listed as inventors of Mayo Clinic intellectual property licensed to Exact Sciences and have rights to receive royalties, paid to Mayo Clinic. Dr. Finney Rutten was previously an Employee of Exact Sciences. No other authors have potential conflicts to disclose.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Mayo Clinic approved this study.

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Ebner, D.W., Burger, K.N., Mahoney, D.W. et al. Neoplasia Diagnosis After Multi-target Stool DNA Is Enhanced Among Lowest Baseline Detectors. Dig Dis Sci 68, 3721–3731 (2023). https://doi.org/10.1007/s10620-023-08038-5

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