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Dig Dis Sci. 2018 Jun;63(6):1449-1453. doi: 10.1007/s10620-018-5001-z. Epub 2018 Mar 7.

Evaluation of Patients with an Apparent False Positive Stool DNA Test: The Role of Repeat Stool DNA Testing.

Author information

1
Division of Gastroenterology, Case Comprehensive Cancer Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Wearn 244, Cleveland, OH, 44106-5066, USA. Gregory.Cooper@Uhhospitals.org.
2
Division of Hematology and Oncology, Case Comprehensive Cancer Center, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44016, USA.
3
Department of Family Medicine and Community Health, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44016, USA.
4
Department of Internal Medicine, University of Michigan School of Medicine, 2150 Cancer Center, Ann Arbor, MI, 48109-5930, USA.
5
Department of Pathology, Case Comprehensive Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44016, USA.
6
Exact Sciences, 441 Charmany Dr, Madison, WI, 53719, USA.
7
Department of Family Medicine and Community Health, Case Comprehensive Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44016, USA.

Abstract

BACKGROUND:

There is uncertainty as to the appropriate follow-up of patients who test positive on multimarker stool DNA (sDNA) testing and have a colonoscopy without neoplasia.

AIMS:

To determine the prevalence of missed colonic or occult upper gastrointestinal neoplasia in patients with an apparent false positive sDNA.

METHODS:

We prospectively identified 30 patients who tested positive with a commercially available sDNA followed by colonoscopy without neoplastic lesions. Patients were invited to undergo repeat sDNA at 11-29 months after the initial test followed by repeat colonoscopy and upper endoscopy. We determined the presence of neoplastic lesions on repeat evaluation stratified by results of repeat sDNA.

RESULTS:

Twelve patients were restudied. Seven patients had a negative second sDNA test and a normal second colonoscopy and upper endoscopy. In contrast, 5 of 12 subjects had a persistently positive second sDNA test, and 3 had positive findings, including a 3-cm sessile transverse colon adenoma with high-grade dysplasia, a 2-cm right colon sessile serrated adenoma with dysplasia, and a nonadvanced colon adenoma (p = 0.045). These corresponded to a positive predictive value of 0.60 (95% CI 0.17-1.00) and a negative predictive value of 1.00 (95% CI 1.00-1.00) for the second sDNA test. In addition, the medical records of all 30 subjects with apparent false positive testing were reviewed and no documented cases of malignant tumors were recorded.

CONCLUSIONS:

Repeat positive sDNA testing may identify a subset of patients with missed or occult colorectal neoplasia after negative colonoscopy for an initially positive sDNA. High-quality colonoscopy with careful attention to the right colon in patients with positive sDNA is critically important and may avoid false negative colonoscopy.

KEYWORDS:

Colon polyps/diagnosis; Colonoscopy; Colorectal neoplasms/diagnosis; DNA/analysis; Early detection of cancer

PMID:
29516325
PMCID:
PMC5960589
DOI:
10.1007/s10620-018-5001-z
[Indexed for MEDLINE]
Free PMC Article

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