Stool-Based Colorectal Cancer Screening Test Performance Characteristics in Those With and Without Hemorrhoids

dc.contributor.authorEbner, Derek W.
dc.contributor.authorRushlow, David
dc.contributor.authorMou, Joshua
dc.contributor.authorPorter, Kyle
dc.contributor.authorFinney Rutten, Lila J.
dc.contributor.authorLimburg, Paul
dc.contributor.authorSancar, Feyza
dc.contributor.authorImperiale, Thomas F.
dc.contributor.departmentMedicine, School of Medicine
dc.description.abstractObjective: To evaluate the effect of hemorrhoids on noninvasive stool test performance for colorectal cancer (CRC) screening. Patients and methods: We conducted a retrospective cohort study of test characteristics for the fecal immunochemical test (FIT) and the multitarget stool DNA (mt-sDNA) test, on the basis of hemorrhoid status, recorded at the time of colonoscopy, among patients enrolled in the pivotal prospective study for mt-sDNA that was conducted from June 2011, to May 2013. Test characteristics (sensitivity, specificity, positive, and negative predictive values) for FIT and mt-sDNA (performed < 90 days before colonoscopy) were stratified by the presence of hemorrhoids and compared. Results: Hemorrhoids were found in 51.7% (5163 of 9989) of the study cohort. Across all test characteristics, there were no statistically significant differences for FIT or mt-sDNA when stratified by hemorrhoid status. Analysis revealed mt-sDNA sensitivity of 44% and 41% for advanced precancerous lesions in nonhemorrhoidal and hemorrhoid patients, respectively (P=.41). The FIT sensitivity among the same lesion category was 24.9% in patients without hemorrhoids and 22.8% in those with hemorrhoids (P=.48). The mt-sDNA specificity was 86.4% in patients without hemorrhoids vs 87.7% in those with hemorrhoids (P=.67), although FIT specificity was 95.0% among patients without hemorrhoids vs 94.7% in those with hemorrhoids (P=.44). Conclusion: The presence of asymptomatic hemorrhoids did not adversely affect test performance in this large clinical study. These findings suggest that in the absence of overt gastrointestinal bleeding, FIT and mt-sDNA are options for CRC screening, irrespective of hemorrhoid status.
dc.eprint.versionFinal published version
dc.identifier.citationEbner DW, Rushlow D, Mou J, et al. Stool-Based Colorectal Cancer Screening Test Performance Characteristics in Those With and Without Hemorrhoids. Mayo Clin Proc Innov Qual Outcomes. 2023;7(4):320-326. Published 2023 Jul 19. doi:10.1016/j.mayocpiqo.2023.06.003
dc.relation.journalMayo Clinic Proceedings: Innovations, Quality & Outcomes
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 Internationalen
dc.subjectColorectal cancer (CRC) screening
dc.subjectFecal immunochemical test (FIT)
dc.titleStool-Based Colorectal Cancer Screening Test Performance Characteristics in Those With and Without Hemorrhoids
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