Factors Associated with False Positive Fecal Immunochemical Tests in Trang Colorectal Cancer Screening Program Population: 4 years results

Aims Colorectal cancer (CRC) screening program for early detection of colorectal cancer is an important global issue. The fecal immunochemical tests (FITs) following by colonoscope examination have been offered as a primary screening test for CRC worldwide as in Trang, Thailand. But FITs accuracy varies according to various factors. The false-positive (FP) FIT results lead to unnecessary colonoscope problem in limited resources hospitals. The primary aim of this study was to identify factors associated with FP FIT results in CRC screening. The secondary aim was to report the 4 years outcomes of the screening program in Trang province [1].

Methods The data from medical records of all 1663 participants with positive FIT tests from the CRC screening program screening conducted in Trang, Thailand between 1 October 2020 and 30 October 2024 were retrospective reviewed. Of these, 1108 participants with complete colonoscopy studies at Trang Hospital were analyzed. Patients’ characteristics, colonoscopy findings, and pathologic data were recorded. Univariable and multivariable logistic regression analysis was performed to determine factors associated with FP FIT results. The SPSS statistical software was used for statistical analyses. Statistically significance was attributed to a p-value<0.05.

Results Among 1108 participants who showed positive FIT with complete colonoscopy for CRC screening, the majority of participants were female gender (68.5%), mean aged was 59.6±6.2 (range; 32-83), BMI<25 kg/m² (54.3.5%) and had no underlying diseases (58.2%). The FP FIT results (no ACRN) were found for 992 participants (89.5%). 116 participants (10.5%) had advanced colorectal neoplasia (ACRN) in this screening program. The most endoscopic finding was normal (478, 43.1%). The abnormal findings were non-advanced adenoma (282, 25.5%), Hyperplastic polyps (125, 11.3%), diverticulosis (94, 8.5%) and hemorrhoid (81, 7.3%). All underlying diseases of participants were not associated with FP. In univariate analysis, female gender (OR=3.05; 95% CI 2.07-4.15; p=<0.001), BMI<25 kg/m² (OR=1.59; 95% CI 1.08-2.35; p=0.023), diverticulosis (OR=3.80; 95% CI 1.19-12.22; p=0.013) and hemorrhoid (OR=0;95% CI 0; p=<0.001) were found associated with FP FIT results. In multivariate logistic regression analysis showed that female gender (OR=3.56; 95% CI 2.37-5.36; p=<0.001), BMI<25 kg/m² (OR=2.04; 95% CI 1.35-3.07; p=<0.001) and diverticulosis (OR=3.90; 95% CI 1.20-12.71; p=0.024) were independent risk factors associated with FP FIT results.

Conclusions The female gender, BMI<25 kg/m² and diverticulosis are significantly associated with FP FIT results. This finding can be used to optimize CRC screening strategies and reduce unnecessary colonoscope exams in a shortage of resource settings.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Nivaarrarsuwonnakul M.. Factor Associated with False Positive Fecal Immunochemical Tests in Trang Colorectal Cancer Screening Program Population. The THAI Journal of SURGERY 2023; 44 (3): 92-97

Publication History

Article published online:
27 March 2025