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Open AccessArticle

Diagnostic Accuracy of Stool Tests for Colorectal Cancer Surveillance in Hodgkin Lymphoma Survivors

1
Department of Gastroenterology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands
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Department of Gastroenterology and Hepatology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
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Department of Gastroenterology and Hepatology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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Department of Radiation Oncology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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Department of Medical Oncology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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Department of Hematology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
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Department of Radiation Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
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Department of Hematology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
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Department of Radiation Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
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Department of Hematology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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Department of Radiation Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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Department of Public Health, Erasmus MC, 3015 GD Rotterdam, The Netherlands
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Department of Pathology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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Department of Epidemiology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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Department of Gastroenterology and Hepatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(1), 190; https://doi.org/10.3390/jcm9010190
Received: 12 December 2019 / Revised: 6 January 2020 / Accepted: 8 January 2020 / Published: 10 January 2020
(This article belongs to the Special Issue Advances in Hodgkin Lymphoma)
Background: Hodgkin lymphoma (HL) survivors have an increased colorectal cancer (CRC) risk. Diagnostic accuracy of quantitative fecal immunochemical testing (FIT, OC Sensor) and/or a multi-target stool DNA test (mt-sDNA, Cologuard®) for advanced neoplasia (AN) was evaluated. Methods: 101 HL survivors underwent a surveillance colonoscopy and were asked to perform two stool tests (FIT and mt-sDNA). Advanced adenoma (AA), advanced serrated lesion (ASL), and AN (AA, ASL, CRC) were evaluated. Sensitivity, specificity, and area under the curve (AUC) for AN were calculated for different FIT cut-offs and mt-sDNA with colonoscopy as reference. Results: FIT and mt-sDNA were analyzed in 73 (72%) and 82 (81%) participants, respectively. AN was detected in 19 (26%) and 22 (27%), respectively. AN sensitivities for FIT cut-off of 10 ug Hb/g feces (FIT10) and mt-sDNA were 37% (95% confidence interval (CI): 16–62) and 68% (95% CI: 45–86), with corresponding specificities of 91% (95% CI: 80–97) and 70% (95% CI: 57–86), respectively. AUC for FIT was 0.68 (95% CI: 0.54–0.82) and for mt-sDNA 0.76 (95% CI: 0.63–0.89). Conclusions: In HL survivors, mt-sDNA showed highest sensitivity but with relatively low specificity for AN. Cost-effectiveness analyses is necessary to determine the optimal surveillance strategy. View Full-Text
Keywords: early detection of cancer; sensitivity and specificity; cancer survivors; Hodgkin lymphoma; colorectal cancer; multi-target stool test; fecal immunochemical testing (FIT) early detection of cancer; sensitivity and specificity; cancer survivors; Hodgkin lymphoma; colorectal cancer; multi-target stool test; fecal immunochemical testing (FIT)
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Ykema, B.; Rigter, L.; Spaander, M.; Moons, L.; Bisseling, T.; Aleman, B.; de Boer, J.P.; Lugtenburg, P.; Janus, C.; Petersen, E.; Roesink, J.; Raemaekers, J.; van der Maazen, R.; Lansdorp-Vogelaar, I.; Gini, A.; Verbeek, W.; Lemmens, M.; Meijer, G.; van Leeuwen, F.; Snaebjornsson, P.; Carvalho, B.; van Leerdam, M. Diagnostic Accuracy of Stool Tests for Colorectal Cancer Surveillance in Hodgkin Lymphoma Survivors. J. Clin. Med. 2020, 9, 190.

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