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Endoscopy 2023; 55(06): 526-534
DOI: 10.1055/a-1971-3488
Original article

Advanced serrated polyps as a target of screening: detection rate and positive predictive value within a fecal immunochemical test-based colorectal cancer screening population

David E. F. W. M. van Toledo
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
 2   Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
 3   Cancer Center Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
,
Emilie C. H. Breekveldt
 4   Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
 5   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
,
Joep E. G. IJspeert
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
 2   Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
 3   Cancer Center Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
,
Anneke J. van Vuuren
 6   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
Folkert J. van Kemenade
 7   Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
Christian Ramakers
 8   Department of Clinical Chemistry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
Iris D. Nagtegaal
 9   Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
,
Monique E. van Leerdam
 5   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
10   Department of Gastroenterology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
,
Manon C. W. Spaander 
 6   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
Iris Lansdorp-Vogelaar
 4   Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
Esther Toes-Zoutendijk
 4   Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
Evelien Dekker 
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
 2   Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
 3   Cancer Center Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
› Author AffiliationsThis analysis has been carried out as part of the national monitoring and evaluation of the CRC screening program, funded by the National Institute for Public Health and the Environment (RIVM). The funder was not involved in the study design, data analysis or writing of the manuscript.
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Referred to by:

The detection rate and yield of advanced relevant serrated polyps: one small step for the yield, one giant leap for the quality of colonoscopyEndoscopy 2023; 55(06): 535-536
DOI: 10.1055/a-2025-0922

Referred to by:

Author commentary on David E. F. W.M. van Toledo et al.Endoscopy 2023; 55(06): v17-v17
DOI: 10.1055/a-1984-1028

Abstract

Background Advanced serrated polyps (ASPs) have a comparable risk to advanced adenomas for progression to colorectal cancer (CRC). The yield of most CRC screening programs, however, is based on advanced adenomas and CRC only. We assessed the ASP detection rate, and positive predictive value (PPV) including ASPs in a fecal immunochemical test (FIT)-based screening program.

Methods We analyzed the findings of follow-up colonoscopies of FIT-positive screenees in the Dutch CRC screening program from 2014 until 2020. Data were retrieved from the national screening and pathology database. An ASP was defined as any serrated polyp of ≥ 10 mm, sessile serrated lesion with dysplasia, or traditional serrated adenoma. The ASP detection rate was defined as the proportion of colonoscopies with ≥ 1 ASP. PPV was originally defined as the proportion of individuals with a CRC or advanced adenoma. The updated PPV definition included CRCs, advanced adenomas, and/or ASPs.

Results 322 882 colonoscopies were included in the analyses. The overall detection rate of ASPs was 5.9 %. ASPs were detected more often in women than men (6.3 % vs. 5.6 %; P < 0.001). ASP detection rates in individuals aged 55–59, 60–64, 65–69, and 70 + were 5.2 %, 6.1 %, 6.1 %, and 5.9 %, respectively (P < 0.001). The PPV for CRCs and advanced adenomas was 41.1 % and increased to 43.8 % when including ASPs. The PPV increase was larger in women than in men (3.2 vs. 2.4 percentage points).

Conclusions 5.9 % of FIT-positive screenees had ASPs, but half of these were detected in combination with a CRC or advanced adenoma. Therefore, including ASPs results in a small increase in the yield of FIT-based screening.



Publication History

Received: 04 July 2022

Accepted after revision: 02 November 2022

Accepted Manuscript online:
02 November 2022

Article published online:
12 January 2023

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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