Reviewing Multitarget Stool DNA versus Fecal Immunochemical Test for CRC Screening

Seum T, Niedermaier T, Heisser T, et al. Next-Generation Multitarget Stool DNA vs. Fecal Immunochemical Test in Colorectal Cancer Screening. JAMA Intern Med. 2024; in press.

Imperiale TF. Is the Multitarget Stool DNA Test Just a Better "FIT" for Colorectal Cancer Screening? JAMA Intern Med. 2024; in press.

According to data reported in 2014, a multitarget stool DNA test that combined DNA analysis with fecal hemoglobin levels had higher sensitivity for detection of colorectal neoplasia, but the test had lower specificity and was available at significantly higher cost compared to the fecal immunochemical (FIT) test.

The authors compared sensitivity and specificity of FIT tests with the multitarget stool DNA test when the cutoff point of the FIT test was lowered from 17 µg/g to 10 µg/g. The data showed that reducing the cutoff point achieved at 96.5% sensitivity for detection of colorectal cancer and a 45.4% sensitivity for detection of any neoplasia with a modestly lower specificity (89%) compared to the DNA test.

The authors suggested that using the FIT test with adjusted cutoff points would be a more economical method for screening patients for colorectal neoplasia.

In the editorial that accompanied the article, Imperiale recommended that additional studies that compare results for the same patient specimens tested with each of tests would be helpful to confirm the accuracy and effectiveness of the FIT test with adjusted cutoff points.