COMMENTARY

Top 10 Practice Changers in Gastroenterology: 2014

David A. Johnson, MD

Disclosures

December 09, 2014

In This Article

Multitarget Stool DNA Testing for Colorectal-Cancer Screening

Imperiale TF, Ransohoff DF, Itzkowitz SH, et al
N Engl J Med. 2014;370:1287-1297

How Do Stool Screening Tests Compare?

The latest iteration of fecal DNA testing is a combination assay that includes molecular tests for KRAS mutations, aberrant NDRG4 and BMP3 methylation, beta-actin, and an immunoassay for hemoglobin by fecal immunochemical testing (FIT). This study compared the performance of this new assay with FIT in detecting CRC in patients undergoing screening colonoscopy.

The sensitivity of the fecal DNA assay was 92.3% for CRC overall (as well as consistent across stages I-III), compared with 73.8% for FIT. Moreover, the sensitivities were 69.2% for high-grade dysplasia and 42.4% for sessile serrated polyps (≥ 1cm), compared with 46.2% and 5.1%, respectively, for FIT.

Clearly, this assay is an effective alternative technology for CRC screening. Whether this will achieve screening in patients who otherwise resist colonoscopy remains to be seen. Furthermore, the cost-effectiveness of detection and prevention of CRC death remains uncertain.

Abstract

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