S322 Sessile Serrated Lesion Detection Rate in Individuals with Positive Fecal Immunohistochemical Test Undergoing Colonoscopy: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Introduction: Fecal immunochemical test (FIT) is a stool-based test recommended by the United States Preventative Services Taskforce (USPSTF) for screening for colorectal cancer (CRC) in average risk individuals. While studies have reported adenoma detection rates in FIT-positive individuals, there is a lack of data on the performance of FIT in detecting sessile serrated lesions (SSLs). We conducted a systematic review and meta-analysis to evaluate the SSL detection rate in individuals with a positive FIT undergoing colonoscopy. Methods: We conducted a comprehensive search of PubMed, Scopus, and Embase databases up to May 2023 to identify studies reporting SSLs in FIT-positive individuals undergoing colonoscopy for average-risk CRC screening. The primary outcome was the overall SSL detection rate, and secondary outcomes included the prevalence of proximal and distal SSLs. A proportion meta-analysis, utilizing the random effects model, was used to generate the pooled rates with their corresponding 95% confidence intervals (CI). I2 adjudicated the heterogeneity. CMA software was used for statistical analysis. Results: Six studies met the inclusion criteria, involving 252,455 FIT-positive individuals undergoing colonoscopy. Average age of patients ranged between 59-62 years, with 45.5% being female. Four of six studies were from North America (US and Canada). Two studies used a FIT positivity threshold of 20 mcg /g feces, while the remaining studies used a threshold of 10 mcg /g feces. A total of 14,026 individuals were found to have at least 1 SSL from a total of 252,455 patients across six studies, for a pooled SSL detection rate of 5.56%. Using random-effects models, the overall SSL detection rate was estimated to be 4.91% (CI: 3.14% - 7.60%; I2: 99%) (Figure 1A). For proximal SSLs, the detection rate was 3.49% (CI: 0.77% - 14.37%; I2: 99%), based on three studies (Figure 1B). For distal SSLs detection, the pooled rate from three studies was 2.05% (CI: 1.17% - 3.57%; I2: 99%) (Figure 1C). Conclusion: Our meta-analysis highlights sessile serrated lesion (SSL) detection rates in FIT-positive individuals undergoing colonoscopy. The findings reveal a significant and variable prevalence of SSLs in this population, with rates differing based on polyp location. Our analysis provides valuable information regarding SSL detection rates in FIT-positive individuals which can be used as a quality benchmark in FIT based population screening programs.Figure 1.: A: Forest plot for metanalysis about prevalence of SSLs among patients with +FIT test undergoing colonoscopies, B: Forest plot for metanalysis about prevalence of proximal SSLs among patients with +FIT test undergoing colonoscopies, C: Forest plot for metanalysis about prevalence of distal SSLs among patients with +FIT test undergoing colonoscopies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.030 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.033 |
| Bibliometrics | 0.009 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".