Sessile serrated polyp detection rates after fecal immunochemical test or multitarget stool DNA test: a systematic review and meta-analysis

Background: Published studies report a higher adenoma detection rate (ADR) for FIT-DNA as compared to FIT. Data is less replete on the performance of stool-based tests on sessile serrated polyp (SSP) detection. We performed meta-analysis to evaluate the performance of FIT and FIT-DNA test on SSP detection rate (SSPDR) for patients undergoing colonoscopy for follow up of positive noninvasive tests. Methods A comprehensive literature search of multiple databases (until September 2022) was performed to identify studies reporting SSPDR in patients with positive FIT or FIT-DNA. The outcome was overall colonoscopy detection of any SSP and an advanced serrated polyps (ASP: SSP ≥ 10 mm and/or dysplasia) Results 482,405 (52.4% females) patients with a mean age of 62.3 ± 4.4 years were included from 23 studies. The pooled SSPDR for all positive stool-based tests was 5.3% and higher for FIT-DNA (15.0%, 95% CI: 8.3 – 25.7) versus FIT (4.1%, 95% CI: 3.0 – 5.6; p=0.0002). The overall pooled ASP detection rate was 1.4% (95% CI: 0.81 – 2.3) and higher in FIT-DNA (3.8 %, 95% CI: 1.7 – 8.6) compared to FIT (0.71%, 95% CI: 0.36 – 1.4; p< 0.01). SSPDR with FIT-DNA was also significantly higher than FIT where FIT cutoff was >10 ug/g and in FIT positive patients in studies conducted in North America (p<0.05). Conclusion FIT-DNA outperformed FIT in both SSP and ASP detection including FIT with a lower threshold cutoff >10 ug/g. Further comparative studies are needed to assess impact of our findings on colorectal cancer reduction.