P1302 - Utility of Fecal Immunochemical Test (FIT) in Detecting Advanced Adenomas in African American Patients

Temitayo Gboluaje, MD¹, Joseph Asemota, MD¹, Martha Gwengi, MS², Owen Igbinosa, MD¹, Hassan Taha, MBBS¹, Sneha Rao Adidam, MD¹, Adeyinka Laiyemo, MD, MPH^3
1Howard University Hospital, Washington, DC; ²Brown University, Providence, RI; ³Howard University College of Medicine, Washington, DC

Introduction: Advanced-adenomas are important precursors in the development of colorectal cancer (CRC). Adenomas are considered advanced if they measure ≥1cm in size, exhibit high-grade dysplasia, or have a villous or tubulovillous histology. Early detection of advanced adenomas is key to significantly reducing the incidence of colorectal carcinoma. Colonoscopy is the gold standard for CRC screening and advance adenoma detection, however due to the existence of several barriers to care, it remains inaccessible to many. African Americans, a group disproportionately affected by CRC, often have significant access challenges and low CRC screening rates. Annual FIT is a recommended alternative, however there is paucity of information on the utility of FIT in detecting advanced adenomas in African Americans.

Methods: Data was obtained from the Electronic Medical Record (EMR) of the largest safety net hospital in the state of Georgia. Our search for patients with both FIT and colonoscopy from 2015 to 2018 using CPT codes, initially yielded 1406 patients. We excluded 256 patients with FIT for non-screening indications, 557 with FIT and colonoscopy greater than 3 months apart, 86 non-African American patients, 7 patients with colon cancer at the time of screening, and 14 patients with incomplete data. A total of 489 patients were included in the final analysis. We evaluated the detection utility of one-time 50µg Hb/g FIT test compared to colonoscopy.

Results: Of the 489 African American patients analyzed, 198 adenomas were identified, of which 51 (25.76%) were advanced. In the cohort, 61.45% were female, the mean age (SD) of study participants with advanced adenoma was 64.32 (8.10). Analysis demonstrated a sensitivity of 55%, specificity of 69%, Positive predictive value (PPV) of 17% and negative predictive value (NPV) of 93% for FIT in the detection of advanced adenoma (p-value: 0.0009).

Discussion: Our study revealed that FIT has a relatively low sensitivity in detecting advanced adenomas in African Americans. However, with a relatively high NPV, it remains a viable tool for early detection of advanced adenoma and screening for CRC, especially in centers with limited resources. Decreasing FIT threshold, although at a cost of higher false positive rates, and sequential testing may improve the advanced adenoma detection utility of FIT. Large multi-center prospective studies are however needed to ascertain these findings presented.



Disclosures:


Temitayo Gboluaje, MD¹, Joseph Asemota, MD¹, Martha Gwengi, MS², Owen Igbinosa, MD¹, Hassan Taha, MBBS¹, Sneha Rao Adidam, MD¹, Adeyinka Laiyemo, MD, MPH³. P1302 - Utility of Fecal Immunochemical Test (FIT) in Detecting Advanced Adenomas in African American Patients, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.