Rate of Detection of Advanced Neoplasms in Proximal Colon by Simulated Sigmoidoscopy vs Fecal Immunochemical Tests
2014; Elsevier BV; Volume: 12; Issue: 10 Linguagem: Inglês
10.1016/j.cgh.2014.03.022
ISSN1542-7714
AutoresAntoni Castells, Enrique Quintero, Cristina Álvarez, Luís Bujanda, Joaquín Cubiella, Dolores Salas, Ángel Lanas, Fernando Carballo, Juan Diego Morillas, Cristina Rodríguez de Miguel, Rodrigo Jover, Elizabeth Hijona, Isabel Portillo, José M. Enríquez–Navascués, Vicent Hernández, Alfonso Martínez-Turnes, Carlos Menéndez-Villalva, Carmen González‐Mao, María Sala, Marta Ponce, Mercedes Andrés, Gloria Teruel, Antonio Peris, Federico Sopeña, Francisca González‐Rubio, Agustín Seoane, Jaume Grau, Anna Serradesanferm, Àngels Pozo, María Pellisé, Francesc Balaguer, Akiko Ono, José Cruzado, Francisco Pérez‐Riquelme, Inmaculada Alonso‐Abreu, Marta Carrillo‐Palau, Mariola de la Vega-Prieto, Rosario Iglesias, Javier Amador, José Manuel Blanco, Rocío Sastre, Juan Ferrándiz, Vicent Hernández, Montserrat Andreu, Xavier Bessa, Ángel Lanas, Francisca González‐Rubio, Alberto Moya-Calvo, Mónica Polo-Tomás, Maria Pilar Roncales, Pilar Sebastian-Martínez, María Ángeles Valencia-Doblas, Nieves Valero-Capilla, Luís Bujanda, María E. Alkiza, Jone M. Altzibar, Pilar Amiano, Juan Arenas, Edurne Artiñano, Ángel Cosme, Isabel Egitegi, Kepa Elorriaga, José Luis Elósegui, José M. Enríquez–Navascués, Cristina Erce, Inês Gil, María A. Gutiérrez-Stampa, Marta Herreros, Elizabeth Hijona, Mariluz Jaúregui, Eva Laredo, Roberto Reséndiz Martínez, María José Mitxelena, Isabel Montalvo, Carlos Placer, Isabel Portillo, Cristina Sarasqueta, Enrique Quintero, Onofre Alarcón, Inmaculada Alonso‐Abreu, Marta Carrillo‐Palau, Mariola de la Vega-Prieto, María Luisa Díez-Fuentes, Antonio Z. Gimeno–García, Yanira González‐Méndez, Manuel Hernández‐Guerra, Renata Linertová, David Nicolás‐Pérez, Juana María Reyes-Melián, Antoni Castells, Montserrat Andreu, Cristina Álvarez, Josep M. Augé, Francesc Balaguer, Mercè Barau, Xavier Bessa, Felipe Bory, Andrea Burón, Antoni Castells, Mercè Comas, Míriam Cuatrecasas, Maria Teresa Rodríguez‐Estrada, Olga Ferrer, Imma Garrell, Jaume Grau, Rafael Guayta, Cristina Hernández, María López‐Cerón, Francesc Macià, Leticia Moreira, Teresa Ocaña, María Pellisé, Mercè Piracés, Sandra Polbach, Àngels Pozo, Marc Puigvehí, Cristina Rodríguez de Miguel, María Sala, Agustín Seoane, Anna Serradesanferm, Judith Sivilla, Antoni Trilla, Joaquín Cubiella, Ma Belén Aguado, Susana Aldecoa, Raquel Ortega, Ana Alonso, Inés Castro, Estela Cid, Lucía Cid, Joan Clofent, Ma Luisa de Castro, Pamela Estévez, Ana Belén Fernández, Ma Dolores González, Simoneta González, Ma Carmen González-Mao, Vicent Hernández, Begoña Iglesias, Felipe Iglesias, Pilar Vieiro Iglesias, Ángeles López-Martínez, Ramiro Macenlle, Alfonso Martínez, David Carral Martínez, Carlos Caballero Menéndez, C. Méndez, José Antonio Hermo, Isabel Pérez, Carmen Portasany, Mar Rionda, Concepción Rivera, Benito Rodrı́guez, Rosa Rodríguez, Manuel Rubio, María Isolina Santiago, Miriam Vázquez, José Ángel Vázquez, Pablo Vega, Ma Carmen Vidal, Raquel Zubizarreta,
Tópico(s)Diverticular Disease and Complications
ResumoBackground & AimsWe compared the ability of biennial fecal immunochemical testing (FIT) and one-time sigmoidoscopy to detect colon side-specific advanced neoplasms in a population-based, multicenter, nationwide, randomized controlled trial.MethodsWe identified asymptomatic men and women, 50–69 years old, through community health registries and randomly assigned them to groups that received a single colonoscopy examination or biennial FIT. Sigmoidoscopy yield was simulated from results obtained from the colonoscopy group, according to the criteria proposed in the UK Flexible Sigmoidoscopy Trial for colonoscopy referral. Patients who underwent FIT and were found to have ≥75 ng hemoglobin/mL were referred for colonoscopy. Data were analyzed from 5059 subjects in the colonoscopy group and 10,507 in the FIT group. The main outcome was rate of detection of any advanced neoplasm proximal to the splenic flexure.ResultsAdvanced neoplasms were detected in 317 subjects (6.3%) in the sigmoidoscopy simulation group compared with 288 (2.7%) in the FIT group (odds ratio for sigmoidoscopy, 2.29; 95% confidence interval, 1.93–2.70; P = .0001). Sigmoidoscopy also detected advanced distal neoplasia in a higher percentage of patients than FIT (odds ratio, 2.61; 95% confidence interval, 2.20–3.10; P = .0001). The methods did not differ significantly in identifying patients with advanced proximal neoplasms (odds ratio, 1.17; 95% confidence interval, 0.78–1.76; P = .44). This was probably due to the lower performance of both strategies in detecting patients with proximal lesions (sigmoidoscopy detected these in 19.1% of patients and FIT in 14.9% of patients) vs distal ones (sigmoidoscopy detected these in 86.8% of patients and FIT in 33.5% of patients). Sigmoidoscopy, but not FIT, detected proximal lesions in lower percentages of women (especially those 50–59 years old) than men.ConclusionsSigmoidoscopy and FIT have similar limitations in detecting advanced proximal neoplasms, which depend on patients' characteristics; sigmoidoscopy underperforms for women 50–59 years old. Screening strategies should be designed on the basis of target population to increase effectiveness and cost-effectiveness. ClinicalTrials.gov number: NCT00906997 We compared the ability of biennial fecal immunochemical testing (FIT) and one-time sigmoidoscopy to detect colon side-specific advanced neoplasms in a population-based, multicenter, nationwide, randomized controlled trial. We identified asymptomatic men and women, 50–69 years old, through community health registries and randomly assigned them to groups that received a single colonoscopy examination or biennial FIT. Sigmoidoscopy yield was simulated from results obtained from the colonoscopy group, according to the criteria proposed in the UK Flexible Sigmoidoscopy Trial for colonoscopy referral. Patients who underwent FIT and were found to have ≥75 ng hemoglobin/mL were referred for colonoscopy. Data were analyzed from 5059 subjects in the colonoscopy group and 10,507 in the FIT group. The main outcome was rate of detection of any advanced neoplasm proximal to the splenic flexure. Advanced neoplasms were detected in 317 subjects (6.3%) in the sigmoidoscopy simulation group compared with 288 (2.7%) in the FIT group (odds ratio for sigmoidoscopy, 2.29; 95% confidence interval, 1.93–2.70; P = .0001). Sigmoidoscopy also detected advanced distal neoplasia in a higher percentage of patients than FIT (odds ratio, 2.61; 95% confidence interval, 2.20–3.10; P = .0001). The methods did not differ significantly in identifying patients with advanced proximal neoplasms (odds ratio, 1.17; 95% confidence interval, 0.78–1.76; P = .44). This was probably due to the lower performance of both strategies in detecting patients with proximal lesions (sigmoidoscopy detected these in 19.1% of patients and FIT in 14.9% of patients) vs distal ones (sigmoidoscopy detected these in 86.8% of patients and FIT in 33.5% of patients). Sigmoidoscopy, but not FIT, detected proximal lesions in lower percentages of women (especially those 50–59 years old) than men. Sigmoidoscopy and FIT have similar limitations in detecting advanced proximal neoplasms, which depend on patients' characteristics; sigmoidoscopy underperforms for women 50–59 years old. Screening strategies should be designed on the basis of target population to increase effectiveness and cost-effectiveness. ClinicalTrials.gov number: NCT00906997
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