Original articleClinical endoscopyA combination of clinical risk stratification and fecal immunochemical test results to prioritize colonoscopy screening in asymptomatic participants

BackgroundStool-based colonoscopy is the preferred strategy for colorectal cancer (CRC) screening. The Asia-Pacific Colorectal Screening System (APCS) score also is helpful in stratifying the risk for advanced neoplasia in the asymptomatic population. The combination of the fecal immunochemical test (FIT) result and clinical risk stratification may be more helpful in stratifying the risk.ObjectiveTo evaluate the value of the combination of FIT and APCS scores in stratifying asymptomatic participants for colonoscopy.DesignCross-sectional study.SettingUniversity hospital.PatientsA total of 948 asymptomatic participants eligible for screening colonoscopy.InterventionsFIT, APCS score evaluation, screening colonoscopy.Main Outcome MeasurementsThe prevalence of colorectal neoplasia in 4 different groups of participants according to FIT and APCS score evaluations.ResultsThe prevalence of non-advanced and advanced neoplasia in the 4 groups (high risk with positive FIT result, high risk with negative FIT result, moderate risk with positive FIT result, and moderate risk with negative FIT result) was 44% versus 36.9%, 30.1% versus 11.6%, 27.1% versus 12%, and 22.6% versus 6.4%, respectively (P < .001). Participants with both high-risk scores and positive FIT results had a significantly higher detection rate of advanced neoplasia (6.15-fold, 95% confidence interval, 3.72-10.17) compared with the other 3 groups. Seven cancers were discovered; 4 were in the high-risk with positive FIT result group.LimitationsHospital-based study.ConclusionIn countries with limited resources, participants with positive FIT results and high-risk scores by APCS should be given priority for colonoscopy because this group is most likely to have advanced neoplasia. However, this strategy needs to be confirmed for its cost-effectiveness in a large, population-based study. (Clinical trial registration number: TCTR20140228001.)