Neoplastic findings after positive multi-target stool DNA testing in a large gastroenterology practice.

BACKGROUND: Multi-target stool DNA (mt-sDNA) testing is a noninvasive colorectal cancer (CRC) screening option, but real-world data on follow-up colonoscopy (FU-CY) completion and findings after positive results are limited. AIM: To evaluate FU-CY completion and advanced neoplasia (AN) after positive mt-sDNA testing. METHODS: Electronic health record data from a convenience sample of adults aged 50-85 years at average risk for CRC with positive mt-sDNA test results between 2014 and 2022 in a large community gastroenterology practice network were analyzed. FU-CY completion was defined as documented FU-CY within 365 days. Outcomes included FU-CY completion, time to FU-CY, and findings. Exploratory logistic regression evaluated factors associated with FU-CY completion. RESULTS: Among 243 patients with positive mt-sDNA test results, 201 (82.7%; 95% confidence interval [CI], 77.4-87.3%) completed FU-CY within 1 year. Median time to FU-CY was 60 days (25th-75th percentile, 39-96 days). AN was identified in 98 patients (48.8%; 95% CI, 41.9-55.7%), driven primarily by advanced precancerous lesions; CRC was detected in 2 patients (1.0%; 95% CI, 0.001-2.4%). The any-neoplasia composite was identified in 168 patients (83.6%; 95% CI, 78.5-88.7%). Age ≥75 years was associated with lower odds of FU-CY completion versus age 50-64 years (odds ratio, 0.28; 95% CI, 0.11-0.73; p < 0.01). CONCLUSION: More than 80% completed FU-CY within 1 year. AN was identified in nearly half of FU-CY completers, driven primarily by APLs.