Introduction
Materials and methods
Study design and study population
Data collection
Statistical analyses
Referral criteria | Details | Ref. |
---|---|---|
Trials | ||
UK FS screening trial | CRC, one distal polyp or adenoma > 1 cm, (tubulo-)villous histology, HGD, ≥ 3 adenomas or ≥ 20 hyperplastic polyps above the rectum | [10] |
SCORE | Distal polyp(s) > 5 mm, (tubulo-)villous histology, HGD, ≥ 3 adenomas or CRC | [5] |
NORCCAP | CRC, one distal polyp ≥ 1 cm or any adenoma | [11] |
US PLCO trial | Score ≥ 4 [age (50–54: 0, 55–59: 1, 60–64: 2, 65–70: 3) + gender (female: 0, male: 1) + most advanced distal finding (no polyps: 0, hyperplasia: 1, tubular adenoma < 10 mm: 2, advanced lesion (tubular adenoma ≥ 10 mm, villous histology, HGD, CRC: 3)] | [6] |
Other | ||
≥ 2 neoplasms, ≥ 1 AN |
At least two distal adenomas, thereof at least one advanced adenoma, or CRC
| |
≥ 2 neoplasms |
At least two distal adenomas or CRC
| |
Histology-defined AN |
Distal (tubulo-)villous adenoma or HGD or CRC
| |
AN ≥ 1 cm | Distal large (≥ 1 cm) adenoma or CRC | |
Any AN | Any distal advanced adenoma or CRC | |
Any neoplasm | Any distal adenoma or CRC; Recommended by several guidelinesa | |
Any neoplasm or HPP | Any distal adenoma or hyperplastic polyp or CRC |
Outcomes
Results
Study population
Characteristic | Total, N = 14,947 | Men, N = 7323 | Women, N = 7624 | |||
---|---|---|---|---|---|---|
N | % | N | % | N | % | |
Age (years) | ||||||
55–59 | 5672 | 37.9 | 2680 | 36.6 | 2992 | 39.2 |
60–64 | 3263 | 21.8 | 1608 | 22.0 | 1655 | 21.7 |
65–69 | 3049 | 20.4 | 1527 | 20.9 | 1522 | 20.0 |
70–74 | 2077 | 13.9 | 1045 | 14.3 | 1032 | 13.5 |
75–79 | 886 | 5.9 | 463 | 6.3 | 423 | 5.5 |
Most advanced finding at screening colonoscopy | ||||||
Colorectal cancer | 213 | 1.4 | 140 | 1.9 | 73 | 1.0 |
Advanced adenoma | 1539a | 10.3 | 985 | 13.5 | 554 | 7.3 |
Non-advanced adenoma | 2988 | 20.0 | 1721 | 23.5 | 1267 | 16.6 |
Hyperplastic polyps | 1568 | 10.5 | 796 | 10.9 | 772 | 10.1 |
Other/unspecified polyps | 362 | 2.4 | 192 | 2.6 | 170 | 2.2 |
No finding | 8277 | 55.4 | 3489 | 47.6 | 4788 | 62.8 |
Diagnostic performance of FS
Sex | Colonoscopy referral criterion after FS screening | Number of colonoscopies | Most advanced finding at colonoscopy | |||||
---|---|---|---|---|---|---|---|---|
CRC (N = 140/73) | AA (N = 971/544) | Any AN (N = 1111/617) | ||||||
N detected | Sensitivity [%] (95% CI) | N detected | Sensitivity [%] (95% CI) | N detectedb | Sensitivity [%] (95% CI) | |||
Men |
No referral
|
0
|
118
| 84 (77–90) |
646
| 67 (63–69) |
752
| 68 (65–70) |
UK FS screening trial | 965 | 126 | 90 (84–94) | 740 | 76 (73–79) | 866 | 78 (75–80) | |
SCORE | 1146 | 126 | 90 (84–94) | 751 | 77 (75–80) | 877 | 79 (76–81) | |
NORCCAP | 2004 | 127 | 91 (85–95) | 787 | 81 (78–83) | 914 | 82 (80–84) | |
US (PLCO)
|
4167
|
135
| 96 (92–99) |
887
| 91 (89–93) |
1022
| 92 (90–94) | |
≥2 neoplasms, ≥ 1 AN |
395
|
122
| 87 (80–92) |
686
| 71 (68–73) |
808
| 73 (70–75) | |
≥2 neoplasms |
630
|
123
| 88 (81–93) |
703
| 72 (69–75) |
826
| 74 (72–77) | |
Histology-defined AN
a
|
617
|
124
| 89 (82–93) |
703
| 72 (69–75) |
827
| 74 (72–77) | |
AN > 1 cm |
639
|
122
| 87 (80–92) |
706
| 73 (70–75) |
828
| 75 (72–77) | |
Any AN | 854 | 125 | 89 (83–94) | 729 | 75 (72–78) | 854 | 77 (74–79) | |
Any neoplasm | 1941 | 127 | 91 (85–95) | 781 | 80 (78–83) | 908 | 82 (79–84) | |
Any neoplasm or HPP | 2737 | 127 | 91 (85–95) | 816 | 84 (82–86) | 943 | 85 (83–87) | |
Women |
No referral
|
0
|
51
| 70 (58–80) |
345
| 63 (59–67) |
395
| 64 (60–68) |
UK FS screening trial | 456 | 52 | 71 (59–81) | 372 | 68 (64–72) | 424 | 69 (65–72) | |
SCORE | 586 | 52 | 71 (59–81) | 377 | 69 (65–73) | 429 | 70 (66–73) | |
US (PLCO)
|
1062
|
57
| 78 (67–87) |
388
| 71 (67–75) |
445
| 72 (68–76) | |
NORCCAP | 1216 | 57 | 78 (67–87) | 396 | 73 (69–76) | 453 | 73 (70–77) | |
≥2 neoplasms, ≥ 1 AN |
152
|
52
| 71 (59–81) |
354
| 65 (61–69) |
406
| 66 (62–70) | |
≥2 neoplasms |
263
|
53
| 73 (61–82) |
358
| 66 (62–70) |
411
| 67 (63–70) | |
Histology-defined AN
a
|
307
|
52
| 71 (59–81) |
363
| 67 (63–71) |
415
| 67 (63–71) | |
AN > 1 cm |
314
|
52
| 71 (59–81) |
359
| 66 (62–70) |
411
| 67 (63–70) | |
Any AN | 422 | 52 | 71 (59–81) | 370 | 68 (64–72) | 422 | 68 (65–72) | |
Any neoplasm | 1186 | 57 | 78 (67–87) | 394 | 72 (68–76) | 451 | 73 (69–77) | |
Any neoplasm or HPP | 1874 | 57 | 78 (67–87) | 412 | 76 (72–79) | 469 | 76 (72–79) | |
Both sexes |
No referral
|
0
|
169
| 79 (73–85) |
991
| 65 (63–68) |
1147
| 66 (64–69) |
UK FS screening trial | 1421 | 178 | 84 (78–88) | 1112 | 73 (71–76) | 1290 | 75 (73–77) | |
SCORE | 1732 | 178 | 84 (78–88) | 1128 | 74 (72–77) | 1306 | 76 (73–78) | |
NORCCAP | 3220 | 184 | 86 (81–91) | 1183 | 78 (76–80) | 1367 | 79 (77–81) | |
US (PLCO)
|
5229
|
192
| 90 (85–94) |
1275
| 84 (82–86) |
1467
| 85 (83–87) | |
≥2 neoplasms, ≥ 1 AN |
547
|
174
| 82 (76–87) |
1040
| 69 (66–71) |
1214
| 70 (68–72) | |
≥2 neoplasms |
893
|
176
| 83 (77–87) |
1061
| 70 (68–72) |
1237
| 72 (69–74) | |
Histology-defined AN
a
|
924
|
176
| 83 (77–87) |
1066
| 70 (68–73) |
1242
| 72 (70–74) | |
AN > 1 cm |
953
|
174
| 82 (76–87) |
1065
| 70 (68–73) |
1239
| 72 (70–74) | |
Any AN | 1276 | 177 | 83 (77–88) | 1099 | 73 (70–75) | 1276 | 74 (72–76) | |
Any neoplasm | 3127 | 184 | 86 (81–91) | 1175 | 78 (75–80) | 1359 | 79 (77–81) | |
Any neoplasm or HPP | 4611 | 184 | 86 (81–91) | 1228 | 81 (79–83) | 1412 | 82 (80–84) |
Colonoscopy referral criterion after FS screening | Men (N = 7323, incl. 359 with prox. AN) | Women (N = 7624, incl. 222 with prox. AN) | Total (N = 14,947, incl. 581 with prox. AN) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Number of colonoscopies N (%)a | Prox. AN detected N (%)b | NCN | Δ NCN | Number of colonoscopies N (%)a | Prox. AN detected N (%)b | NCN | Δ NCN | Number of colonoscopies N (%)a | Prox. AN detected N (%)b | NCN | Δ NCN | |
UK FS screening trial | 965 (13) | 114 (32) | 8.5 | 9.8 | 456 (6) | 29 (13) | 15.7 | 16.9 | 1421 (10) | 143 (25) | 9.9 | 11.5 |
SCORE | 1146 (16) | 125 (35) | 9.2 | 10.9 | 586 (8) | 34 (15) | 17.2 | 18.9 | 1732 (12) | 159 (27) | 10.9 | 12.9 |
NORCCAP | 2004 (27) | 162 (45) | 12.4 | 15.2 | 1216 (16) | 58 (26) | 21.0 | 22.6 | 3220 (22) | 220 (38) | 14.6 | 17.5 |
US (PLCO)
|
4167 (57)
|
270 (75)
|
15.4
|
17.6
|
1062 (14)
|
50 (23)
|
21.2
|
23.3
|
5229 (35)
|
320 (55)
|
16.3
|
18.5
|
≥2 neoplasms, ≥ 1 AN |
395 (5)
|
56 (16)
|
7.1
|
Ref.
|
152 (2)
|
11 (5)
|
13.8
|
Ref.
|
547 (4)
|
67 (12)
|
8.2
|
Ref.
|
≥2 neoplasms |
630 (9)
|
74 (21)
|
8.5
|
13.1
|
263 (3)
|
16 (7)
|
16.4
|
22.2
|
893 (6)
|
90 (15)
|
9.9
|
15.0
|
Histology-defined AN
c
|
617 (8)
|
75 (21)
|
8.2
|
11.7
|
307 (4)
|
20 (9)
|
15.4
|
17.2
|
924 (6)
|
95 (16)
|
9.7
|
13.5
|
AN > 1 cm |
639 (9)
|
76 (21)
|
8.4
|
12.2
|
314 (4)
|
16 (7)
|
19.6
|
32.4
|
953 (6)
|
92 (16)
|
10.4
|
16.2
|
Any AN | 854 (12) | 102 (28) | 8.4 | 10.0 | 422 (6) | 27 (12) | 15.6 | 16.9 | 1276 (9) | 129 (22) | 9.9 | 11.8 |
Any neoplasm | 1941 (27) | 156 (43) | 12.4 | 15.5 | 1186 (16) | 56 (25) | 21.2 | 23.0 | 3127 (21) | 212 (36) | 14.8 | 17.8 |
Any neoplasm or HPP | 2737 (37) | 191 (53) | 14.3 | 17.3 | 1874 (25) | 74 (33) | 25.3 | 27.3 | 4611 (31) | 265 (46) | 17.4 | 20.5 |