Performance of quantitative immunochemical test for fecal hemoglobin for surveillance of colorectal neoplasia after polypectomy in clinical practice

摘要

Aims: We examined the yield of immunochemical test for fecal hemoglobin (FIT) for the post-polypectomy individuals in a colorectal cancer screening program. Methods: We enrolled 50-75 years average-risk individuals who attended a biennial FIT-based colorectal cancer screening program from March 2010 to December 2011 (index round) and from January 2012 to December 2013 (repeated round). Colonoscopy was recommended to the participants with an FIT >= 30 ug Hb/g feces. Participants identified with adenomas and removed by polypectomy in the index round were defined as surveillance group (Sur-G). Participants with an FIT < 30 ug Hb/g feces in the index round or identified as non-neoplastic findings of the indexed colonoscopy were defined as repeated screening group (Rsc-G). We compared key quality indicators for FIT and colonoscopy between Sur-G and Rsc-G according to the findings of the repeated round. A p < 0.05 determined by chi-square test was defined as significant. Results: There were 222 post-polypectomy surveillance (Sur-G) and 7311 repeated screening individuals (Rsc-G) enrolled for analysis. The FIT positivity rate, colonoscopy compliance rate and colorectal neoplasia (CRN) detection rate were 504 of 7311 (6.9%) vs. 46 of 222 (20.7%) (p < 0.001); 381 of 504 (75.6%) vs. 44 of 46 (95.7%) (p < 0.001) and 207 of 504 (41.1%) vs. 32 of 46 (69.6%) (p < 0.001) for Rsc-G and Sur-G respectively. The FIT positivity rate, colonoscopy compliance rate and CRN detection rate were significantly higher in the Sur-G. Conclusions: Our results suggest individuals after polypectomy still had high risk of CRN. Biennial FIT may play a role for post-polypectomy surveillance. Subsequent prospective study is necessary to evaluate the effectiveness of FIT for post-polypectomy surveillance.