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Colorectal Cancer Fast Tracks: Cancer Yield and the Predictive Value of Entry Criteria
Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Internal Medicine, Division of Gastroenterology.ORCID iD: 0000-0002-0942-0816
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Internal Medicine, Division of Gastroenterology.ORCID iD: 0000-0001-6348-2308
2023 (English)In: Cancers, ISSN 2072-6694, Vol. 15, no 19, article id 4778Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Fast-track pathways for diagnosing colorectal cancer (CRC) have been implemented in several European countries. In Sweden, a substantial number of CRC are diagnosed via the Swedish Standardized Course of Care for colorectal cancer (SCC-CRC). We evaluated the SCC-CRC in terms of CRC yield, and predictive values and odds ratios (OR) for the entry criteria.

METHODS: We retrospectively analyzed all 2539 patients referred for SCC-CRC colonoscopy between September 2016 and December 2020. Entry criteria and colonoscopy outcomes were analyzed.

RESULTS: CRC yield was 16.4%. Highest positive predictive values (PPVs) were seen for abnormal radiology (PPV 30.5%, OR 4.7 (95% CI 3.4-6.4) p < 0.001), abnormal rectal examination (PPV 28%, OR 3.6 (95% CI 2.7-4.8) p < 0.001), and anemia (PPV 24.8%, OR 2.2 (95% CI 1.5-3.1) p < 0.001). Some entry criteria showed no significant risk increase, i.e., visible blood in stool/rectal bleeding, change in bowel habits, and the combination of changed bowel habits plus anemia. A positive fecal immunochemical test (FIT), although not part of the SCC-CRC, showed the highest OR: 9.9 (95% CI 4.5-21.7) p < 0.001) and PPV of 18.8%.

CONCLUSIONS: CRC yield from the SCC-CRC is slightly higher compared to other European fast tracks. A number of entry criteria showed no benefit towards assessing CRC risk. FIT testing should be included in CRC fast tracks to increase diagnostic efficacy.

Place, publisher, year, edition, pages
MDPI, 2023. Vol. 15, no 19, article id 4778
Keywords [en]
Colonoscopy, colorectal carcinoma, epidemiology, screening, symptoms
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-108981DOI: 10.3390/cancers15194778ISI: 001084619900001PubMedID: 37835472Scopus ID: 2-s2.0-85173902893OAI: oai:DiVA.org:oru-108981DiVA, id: diva2:1805062
Available from: 2023-10-16 Created: 2023-10-16 Last updated: 2025-02-11Bibliographically approved

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Nyhlin, Nilsvan Nieuwenhoven, Michiel A

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