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Su1648 A New-Generation Fecal Immunochemical Test (Fit) Is Superior to Quaiac-Based Test in Detecting Fecal Occult Blood (FOB) Among Colonoscopy Referral Patients in Barretos, Brazil
Abstracts
Su1647 How to Calculate Post Colonoscopy Colorectal Cancer (PCCRC) Rates? Results Using Different Methods Applied to the Same Dataset in Belgium Elizabeth Macken*1, Stefan Van dongen2, Roland Valori3, Guido van Hal2 1 UZ Antwerpen, Edegem, Belgium; 2University of Antwerp, Antwerp, Belgium; 3Gloucestershire Hospitals, Gloucester, United Kingdom Background: : Post colonoscopy colorectal cancers (PCCRC) are colorectal cancers (CRC) that are diagnosed after a negative examination. These cancers are an important marker of colonoscopy quality but difficult to measure. Aim : We calculated PCCRC rates in Belgium for the period 2002-2010 using previously published methods and compared the results. Methods: In Belgium, 1,326,126 full colonoscopies were performed in 994,047 patients in 9 years. A further 611,669 procedures, termed left sided colonoscopies, were performed in 417,382 patients, during the same period. Left sided colonoscopy is a term used in Belgium for procedures extending beyond the rectum up to the transverse colon. We calculated PCCRC rates for full colonoscopy using five different published methods (Morris et al, Gut, 2014) for all procedures performed in Belgium between 2002-2010. We also calculated rates for left sided colonoscopy using the new method. We used no exclusion criteria. However, because of the time perspective of the method: look forward from colonoscopy rather than look back from cancer diagnosis, data from 2008-2010 were omitted for the new colonoscopy method and from 2002-2004 for all the other methods. The most common approach to calculate PCCRC rates looks back from the date of diagnosis and uses the total number of individuals with cancer as the denominator. Basically the PCCRC rate is calculated as PCCRC divided by all patients with CRC, but the methods differ in omitting patients with a recent colonoscopy (Bressler), in counting the patients with PCCRC in the denominator (Singh) or including all patients diagnosed with CRC (colonoscopy not necessary)(LeClercq). The new colonoscopy method (Morris, Gut, 2014) looks forward from the date of colonoscopy, and designates PCCRC as a cancer diagnosed between 6-36 months after colonoscopy. Colonoscopies (true positive and false negatives), and not individuals, are the denominator. Results: There is wide variation in rates of PCCRC using the different methods with the same dataset. PCCRC ranges from 1.38 % (Bressler), to 2.14 % (LeClercq), 4.62 % (Cooper), and 5.38 % (Singh). The new method gave a PCCRC rate for full colonoscopy of 7.55 % and left colonoscopy of 8.9 %. Figure 1 shows the cumulative results. Conclusions: Different methods to calculate PCCRC using the same dataset give wide variation in rates. Procedures that do not intubate the proximal colon are associated with a higher rate of PCCRC. Comparison between countries is only possible if the same method is used to calculate the rate. The new method of calculating PCCRC rates seems a logical and clear way to use PCCRC as a marker of colonoscopy quality.
Su1648 A New-Generation Fecal Immunochemical Test (Fit) Is Superior to Quaiac-Based Test in Detecting Fecal Occult Blood (FOB) Among Colonoscopy Referral Patients in Barretos, Brazil Denise P. Guimaraes*1,2, Jose Humberto T. Fregnani2, Rui M. Reis2, Leonardo N. Taveira1, Cristovam Scapulatempo-Neto3, Marcus M. Matsushita3, Sandra R. Silva3, Cleyton Z. Oliveira4, Carita Eklund5, Panu H. Hendolin5, Lea I. Paloheimo5, Edmundo Mauad6, Kari J. Syrjänen7 1 Department of Endoscopy, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; 2Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; 3Department of Pathology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; 4Department of Biostatistics, Barretos Cancer Hospital, Barretos, Brazil; 5Department of Research and Development, Biohit Oyj, Helsinki, Finland; 6Cancer Prevention Department, Barretos Cancer Hospital, BARRETOS, SÃO PAULO, Brazil; 7Department of Clinical Research, Biohit Oyj, Helsinki, Finland Backgound: Immunochemical fecal test (FIT) has a relevant role in colorectal screening. Objective: To compare a new-generation fecal immunochemical test (FIT) test with the leading guaiac-based test in detection of fecal occult blood (FOB) in colonoscopy-referral patients. Methods: A cohort of 442 patients referred for colonoscopy at Barretos Cancer Hospital (BCH) was examined by two different tests for FOB: ColonView quick test (CV; Biohit Oyj, Finland)(FIT test for Hb and Hb/Hp complex) and HemoccultSENSA (HS; Beckman Coulter, USA)(quaiac test for Hb). Three fecal samples were requested and all subjects were examined by diagnostic colonoscopy with biopsy verification. The test was interpreted as positive if any of at least two samples tested positive for Hb (HS test), and Hb or Hb/Hp complex (CV test). The latter was interpreted both by visual and automatic reading. The performance indicators [sensitivity (SE), specificity (SP), PPV, NPV and AUC)] were calculated for both tests using four endpoints [adenoma (A), adenoma/carcinoma (A/AC), advanced adenoma (AA) and carcinoma (AC)]. The two tests were compared by their sensitivity/specificity balance (AUC), using ROC (receiver operating characteristics) comparison test. Results: A total of 304 of 442 patients had at least two adequate test for both tests. Colonoscopy (and biopsies) disclosed normal results in 53 (17.4%) subjects, A in 124 (40.8%) cases, AA in 34 cases (11.2%), and AC in 36 (11.8%) patients, the remaining 57 cases (18.8%) representing benign lesions (nontumor conditions or hyperplastic polyps). For AC endpoint, HS test had SE of 77.8% and SP of 79.3% (AUCZ0.785), while visual Hb CV test had 91.7% SE and 75.5% SP (AUCZ0.836)(pZ0.063; pZ0.815). For the combined A+AC endpoint, HS test had SE of 32.5% and SP of 79.3% (AUCZ0.559), while CV test had 52.5% SE and 75.5% SP (AUCZ0.640)(p<0.001; pZ0.815). For the A endpoint, the difference between HS and CV was even more significant, SE of 19.4% and SP of 79.3% (AUCZ0.493) and SE of 41.1% and SP of 75.5% (AUCZ0.493), respectively (p<0.001; pZ0.583). In CV test, there was no difference in terms of SE between Hb alone and Hb/Hp complex for A (41.9% vs. 41.1%) and C (91.7% vs. 94.4%) endpoints, respectively. Conclusions: ColonView sensitivity is superior to Hemoccult test and current FIT tests on the market, recently shown to exhibit pooled SE of 79% for CRC in a comprehensive meta-analysis. With these performance indicators, ColonView quick test can be the test-of-choice for CRC screening programs.
Su1649 Higher Incidence of Advanced Neoplasia in Patients With Left-Sided Colorectal Cancer Resection and Synchronous Advanced Neoplasia: Do We Need to Change the Surveillance Protocol Based on the Resection Type and the Baseline Colonoscopy Findings? Yohei Yabuuchi*, Kenichiro Imai, Kinichi Hotta, Sayo Ito, Masaki Tanaka, Noboru Kawata, Naomi Kakushima, Kohei Takizawa, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, Hiroyuki Ono Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan Background: A higher adenoma detection rate after left-sided colectomy than rightsided colectomy has been reported recently, but the relationship between the resection type and advanced adenoma detection rate is unclear. Although the recommended surveillance intervals after screening colonoscopy are determined by the baseline colonoscopy findings, there are limited available data on risk stratification after colorectal cancer (CRC) surgery. Aims: This retrospective cohort study aimed to evaluate the incidence of metachronous advanced neoplasia (AN), defined as CRC or advanced adenoma (10 mm or villous histology or high-grade dysplasia), after colorectal surgery according to resection type and the findings at baseline colonoscopy. Methods: Consecutive patients who underwent surgery for CRC at a Japanese tertiary cancer center from September 2002 to December 2012 were included. Patients with a diagnosis of TNM stage 4, familial adenomatous polyposis, Lynch syndrome, inflammatory bowel disease, a previous history of CRC, or who underwent total or multi-segment colorectal resection were excluded. Patients were
www.giejournal.org
Volume 85, No. 5S : 2017 GASTROINTESTINAL ENDOSCOPY AB379
Su1647 How to Calculate Post Colonoscopy Colorectal Cancer (PCCRC) Rates? Results Using Different Methods Applied to the Same Dataset in Belgium Elizabeth Macken*1, Stefan Van dongen2, Roland Valori3, Guido van Hal2 1 UZ Antwerpen, Edegem, Belgium; 2University of Antwerp, Antwerp, Belgium; 3Gloucestershire Hospitals, Gloucester, United Kingdom Background: : Post colonoscopy colorectal cancers (PCCRC) are colorectal cancers (CRC) that are diagnosed after a negative examination. These cancers are an important marker of colonoscopy quality but difficult to measure. Aim : We calculated PCCRC rates in Belgium for the period 2002-2010 using previously published methods and compared the results. Methods: In Belgium, 1,326,126 full colonoscopies were performed in 994,047 patients in 9 years. A further 611,669 procedures, termed left sided colonoscopies, were performed in 417,382 patients, during the same period. Left sided colonoscopy is a term used in Belgium for procedures extending beyond the rectum up to the transverse colon. We calculated PCCRC rates for full colonoscopy using five different published methods (Morris et al, Gut, 2014) for all procedures performed in Belgium between 2002-2010. We also calculated rates for left sided colonoscopy using the new method. We used no exclusion criteria. However, because of the time perspective of the method: look forward from colonoscopy rather than look back from cancer diagnosis, data from 2008-2010 were omitted for the new colonoscopy method and from 2002-2004 for all the other methods. The most common approach to calculate PCCRC rates looks back from the date of diagnosis and uses the total number of individuals with cancer as the denominator. Basically the PCCRC rate is calculated as PCCRC divided by all patients with CRC, but the methods differ in omitting patients with a recent colonoscopy (Bressler), in counting the patients with PCCRC in the denominator (Singh) or including all patients diagnosed with CRC (colonoscopy not necessary)(LeClercq). The new colonoscopy method (Morris, Gut, 2014) looks forward from the date of colonoscopy, and designates PCCRC as a cancer diagnosed between 6-36 months after colonoscopy. Colonoscopies (true positive and false negatives), and not individuals, are the denominator. Results: There is wide variation in rates of PCCRC using the different methods with the same dataset. PCCRC ranges from 1.38 % (Bressler), to 2.14 % (LeClercq), 4.62 % (Cooper), and 5.38 % (Singh). The new method gave a PCCRC rate for full colonoscopy of 7.55 % and left colonoscopy of 8.9 %. Figure 1 shows the cumulative results. Conclusions: Different methods to calculate PCCRC using the same dataset give wide variation in rates. Procedures that do not intubate the proximal colon are associated with a higher rate of PCCRC. Comparison between countries is only possible if the same method is used to calculate the rate. The new method of calculating PCCRC rates seems a logical and clear way to use PCCRC as a marker of colonoscopy quality.
Su1648 A New-Generation Fecal Immunochemical Test (Fit) Is Superior to Quaiac-Based Test in Detecting Fecal Occult Blood (FOB) Among Colonoscopy Referral Patients in Barretos, Brazil Denise P. Guimaraes*1,2, Jose Humberto T. Fregnani2, Rui M. Reis2, Leonardo N. Taveira1, Cristovam Scapulatempo-Neto3, Marcus M. Matsushita3, Sandra R. Silva3, Cleyton Z. Oliveira4, Carita Eklund5, Panu H. Hendolin5, Lea I. Paloheimo5, Edmundo Mauad6, Kari J. Syrjänen7 1 Department of Endoscopy, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; 2Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; 3Department of Pathology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; 4Department of Biostatistics, Barretos Cancer Hospital, Barretos, Brazil; 5Department of Research and Development, Biohit Oyj, Helsinki, Finland; 6Cancer Prevention Department, Barretos Cancer Hospital, BARRETOS, SÃO PAULO, Brazil; 7Department of Clinical Research, Biohit Oyj, Helsinki, Finland Backgound: Immunochemical fecal test (FIT) has a relevant role in colorectal screening. Objective: To compare a new-generation fecal immunochemical test (FIT) test with the leading guaiac-based test in detection of fecal occult blood (FOB) in colonoscopy-referral patients. Methods: A cohort of 442 patients referred for colonoscopy at Barretos Cancer Hospital (BCH) was examined by two different tests for FOB: ColonView quick test (CV; Biohit Oyj, Finland)(FIT test for Hb and Hb/Hp complex) and HemoccultSENSA (HS; Beckman Coulter, USA)(quaiac test for Hb). Three fecal samples were requested and all subjects were examined by diagnostic colonoscopy with biopsy verification. The test was interpreted as positive if any of at least two samples tested positive for Hb (HS test), and Hb or Hb/Hp complex (CV test). The latter was interpreted both by visual and automatic reading. The performance indicators [sensitivity (SE), specificity (SP), PPV, NPV and AUC)] were calculated for both tests using four endpoints [adenoma (A), adenoma/carcinoma (A/AC), advanced adenoma (AA) and carcinoma (AC)]. The two tests were compared by their sensitivity/specificity balance (AUC), using ROC (receiver operating characteristics) comparison test. Results: A total of 304 of 442 patients had at least two adequate test for both tests. Colonoscopy (and biopsies) disclosed normal results in 53 (17.4%) subjects, A in 124 (40.8%) cases, AA in 34 cases (11.2%), and AC in 36 (11.8%) patients, the remaining 57 cases (18.8%) representing benign lesions (nontumor conditions or hyperplastic polyps). For AC endpoint, HS test had SE of 77.8% and SP of 79.3% (AUCZ0.785), while visual Hb CV test had 91.7% SE and 75.5% SP (AUCZ0.836)(pZ0.063; pZ0.815). For the combined A+AC endpoint, HS test had SE of 32.5% and SP of 79.3% (AUCZ0.559), while CV test had 52.5% SE and 75.5% SP (AUCZ0.640)(p<0.001; pZ0.815). For the A endpoint, the difference between HS and CV was even more significant, SE of 19.4% and SP of 79.3% (AUCZ0.493) and SE of 41.1% and SP of 75.5% (AUCZ0.493), respectively (p<0.001; pZ0.583). In CV test, there was no difference in terms of SE between Hb alone and Hb/Hp complex for A (41.9% vs. 41.1%) and C (91.7% vs. 94.4%) endpoints, respectively. Conclusions: ColonView sensitivity is superior to Hemoccult test and current FIT tests on the market, recently shown to exhibit pooled SE of 79% for CRC in a comprehensive meta-analysis. With these performance indicators, ColonView quick test can be the test-of-choice for CRC screening programs.
Su1649 Higher Incidence of Advanced Neoplasia in Patients With Left-Sided Colorectal Cancer Resection and Synchronous Advanced Neoplasia: Do We Need to Change the Surveillance Protocol Based on the Resection Type and the Baseline Colonoscopy Findings? Yohei Yabuuchi*, Kenichiro Imai, Kinichi Hotta, Sayo Ito, Masaki Tanaka, Noboru Kawata, Naomi Kakushima, Kohei Takizawa, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, Hiroyuki Ono Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan Background: A higher adenoma detection rate after left-sided colectomy than rightsided colectomy has been reported recently, but the relationship between the resection type and advanced adenoma detection rate is unclear. Although the recommended surveillance intervals after screening colonoscopy are determined by the baseline colonoscopy findings, there are limited available data on risk stratification after colorectal cancer (CRC) surgery. Aims: This retrospective cohort study aimed to evaluate the incidence of metachronous advanced neoplasia (AN), defined as CRC or advanced adenoma (10 mm or villous histology or high-grade dysplasia), after colorectal surgery according to resection type and the findings at baseline colonoscopy. Methods: Consecutive patients who underwent surgery for CRC at a Japanese tertiary cancer center from September 2002 to December 2012 were included. Patients with a diagnosis of TNM stage 4, familial adenomatous polyposis, Lynch syndrome, inflammatory bowel disease, a previous history of CRC, or who underwent total or multi-segment colorectal resection were excluded. Patients were
www.giejournal.org
Volume 85, No. 5S : 2017 GASTROINTESTINAL ENDOSCOPY AB379