Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2018; 24(34): 3919-3926
Published online Sep 14, 2018. doi: 10.3748/wjg.v24.i34.3919
Predicting the presence of adenomatous polyps during colonoscopy with National Cancer Institute Colorectal Cancer Risk-Assessment Tool
Hassan Tariq, Muhammad Umar Kamal, Harish Patel, Ravi Patel, Muhammad Ameen, Shehi Elona, Maram Khalifa, Sara Azam, Aiyi Zhang, Kishore Kumar, Ahmed Baiomi, Danial Shaikh, Jasbir Makker
Hassan Tariq, Harish Patel, Kishore Kumar, Jasbir Makker, Division of Gastroenterology, Department of Medicine, BronxCare Health system, Bronx, NY 10457, United States
Muhammad Umar Kamal, Ravi Patel, Muhammad Ameen, Shehi Elona, Maram Khalifa, Sara Azam, Aiyi Zhang, Ahmed Baiomi, Danial Shaikh, Department of Medicine, BronxCare Health system, Bronx, NY 10457, United States
Author contributions: Tariq H, Kamal MU, Patel H and Makker J contributed to concept and design; Patel R, Ameen M, Shehi E, Khalifa M and Azam S contributed to acquisition of data; Tariq H, Kamal MU, Patel H, Zhang A and Makker J contributed to analysis and interpretation of data; Tariq H, Kamal MU, Patel H, Baiomi A, Shaikh D and Makker J drafted the manuscript, Tariq H, Kamal MU, Patel H, Kumar K and Makker J contributed to critical revision of the manuscript for important intellectual content; Zhang A performed statistical analysis; Patel H, Baiomi A and Makker J contributed to study supervision.
Institutional review board statement: The study was performed in agreement with the ethical guidelines of the Declaration of Helsinki and the protocol was approved by the local Ethics Committee (IRN# 12 14 17 13).
Informed consent statement: All participants have given written informed consent before inclusion in the study.
Conflict-of-interest statement: All authors declare no financial support or conflict of interest.
Data sharing statement: The raw data used for all analyses are available from the corresponding author.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Muhammad Umar Kamal, MD, Doctor, Resident Physician, Department of Medicine, BronxCare Health system, 1650 Selwyn Avenue, Apt 10C, Bronx, NY 10457, United States. muhammadumarkamal@gmail.com
Telephone: +1-718-9601234 Fax: +1-718-9602055
Received: July 2, 2018
Peer-review started: July 3, 2018
First decision: July 18, 2018
Revised: July 25, 2018
Accepted: August 1, 2018
Article in press: August 1, 2018
Published online: September 14, 2018
Processing time: 74 Days and 3.6 Hours
Abstract
AIM

To evaluate the National Cancer Institute (NCI) Colorectal Cancer (CRC) Risk Assessment Tool as a predictor for the presence of adenomatous polyps (AP) found during screening or surveillance colonoscopy.

METHODS

This is a retrospective single center observational study. We collected data of adenomatous polyps in each colonoscopy and then evaluated the lifetime CRC risk. We calculated the AP prevalence across risk score quintiles, odds ratios of the prevalence of AP across risk score quintiles, area under curves (AUCs) and Youden’s indexes to assess the optimal risk score cut off value for AP prevalence status.

RESULTS

The prevalence of AP gradually increased throughout the five risk score quintiles: i.e., 27.63% in the first and 51.35% in the fifth quintile. The odd ratios of AP prevalence in the fifth quintile compared to the first and second quintile were 2.76 [confidence interval (CI): 1.71-4.47] and 2.09 (CI: 1.32-3.30). The AUC for all patients was 0.62 (CI: 0.58-0.66). Youden’s Index indicated the optimal risk score cutoff value discriminating AP prevalence status was 3.60.

CONCLUSION

Patients with the higher NCI risk score have higher risk of AP and subsequent CRC; therefore, measures to increase the effectiveness of CRC detection in these patients include longer withdrawal time, early surveillance colonoscopy, and choosing flexible colonoscopy over other CRC screening modalities.

Keywords: National Cancer Institute Colorectal Cancer Risk-Assessment Tool; Colorectal cancer; Predictors of colorectal cancer; Adenomatous polyps; Colonoscopy

Core tip: Due to health, financial and social burden of colorectal cancer (CRC), it is necessary to assess the risk of cancer development earlier. National Cancer Institute (NCI) CRC risk prediction model helps identifying people who are at increased risk of developing CRC. Our study demonstrated that NCI CRC risk prediction tool could also estimate the risk of having Adenomatous polyps (AP) in patients undergoing screening or surveillance colonoscopy. The results revealed that the odds ratios of AP prevalence increase progressively throughout the five quintiles of risk scores. Therefore, measures to increase the effectiveness of CRC screening in these patients should be implemented using longer withdrawal times, early surveillance colonoscopy, and choosing flexible colonoscopy over other CRC screening modalities.