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Accuracy of fecal immunochemical tests for detecting advanced colorectal neoplasia at surveillance colonoscopy
Journal article   Open access   Peer reviewed

Accuracy of fecal immunochemical tests for detecting advanced colorectal neoplasia at surveillance colonoscopy

Richard M Hoffman, Yinghui Xu, Seth D Crockett, Jeanette M Daly, Gloria D Coronado and Barcey T Levy
Clinical and translational gastroenterology
02/06/2026
DOI: 10.14309/ctg.0000000000000997
PMID: 41649177
url
https://doi.org/10.14309/ctg.0000000000000997View
Published (Version of record) Open Access

Abstract

US guidelines recommend surveillance colonoscopy following polyp removal, but stool testing may offer a more efficient, acceptable strategy for patients with non-advanced lesions. We conducted exploratory analyses to evaluate the diagnostic accuracy of quantitative FIT results to diagnose advanced colorectal neoplasia (ACN) in patients undergoing surveillance colonoscopy. We classified patients by prior colonoscopy findings as having low, intermediate, or high risk polyps. We compared the diagnostic performance for detecting ACN at an optimal cutoff identified by the Youden index versus the standard cutoff of 100 ng/mL. We also estimated cumulative sensitivity and specificity for serial FIT testing in patients with non-advanced findings. Among the 449 participants (mean ± SD age 65.4 ±7.1, 53.2% female, and 92.7% white), the median interval between colonoscopies was 5.0 years (IQR 3.5, 5.6); adequate or better bowel prep was achieved in 89.3% and cecal intubation in 98.4%. We detected 55 advanced-precancerous lesions (APL), but no cancers. For patients with prior non-advanced lesions (n = 378), the optimal cutoff was 26 ng/mL. Compared with the standard cutoff, the optimal cutoff increased sensitivity (14.3% to 35.7%, p <0.01) but reduced specificity (95.5% to 79.2%, p <0.01). Estimated cumulative sensitivity across 3 rounds of FIT testing was 73.4% at the optimal cutoff versus 37.1% with the standard cutoff. Lowering the FIT hemoglobin cutoff markedly improved sensitivity for detecting APL in patients without prior advanced polyps. Serial testing could further enhance detection. FIT-based surveillance should be further evaluated as a potential strategy to prioritize, delay, or replace colonoscopy.
 surveillance colonoscopy colorectal neoplasms sensitivity and specificity fecal immunochemical test

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