P0341 - A Single Center Review of Patients With Discordant Cologuard Testing and Screening Colonoscopy: Who Are These Patients and What Is Being Recommended?

Nicholas Talabiska, DO, Neil Mehta, MD, Shelby McNeilly, DO, Henry P Parkman, MD
Temple University Hospital, Philadelphia, PA

Introduction: Advances in non-invasive testing for colorectal cancer (CRC) screening have led to the adoption of non-invasive multi-target stool DNA testing (e.g. Cologuard). If a patient has a positive Cologuard test then a colonoscopy is strongly recommended. However, “discordant studies” with a positive Cologuard test and negative colonoscopy remains a point of controversy when deciding future surveillance intervals. Herein, we reviewed patients with discordant studies at an urban, tertiary care center to better understand demographics, surveillance recommendations and outcomes.

Methods: A retrospective chart review was conducted for patients who had undergone a Cologuard test for CRC screening from January 2014 until January 2022. An EPIC query included individuals ≥45 years old undergoing a Cologuard test for CRC screening, average- and high-risk patients, and those who completed a Cologuard test with a positive or negative result. Data including demographics, procedure results, and screening recommendations were collected.

Results: 420 patient charts with successfully completed Cologuard tests were identified. There were 100 high-risk patients in this cohort, albeit against USPSTF guidelines. There were 228 negative Cologuard tests. This cohort had no interval CRC cases and were to continue non-invasive testing, if desired. There were 192 positive Cologuard tests and 165 subsequently completed a screening colonoscopy. 69.1% had any number of polyps present. 83.6% had a combination of diverticulosis and/or internal/external hemorrhoids. 3 cases of CRC were diagnosed. The most commonly recommended surveillance intervals were 3 and 5 years.



There were 103 discordant studies. Of these, 13 were recommended to repeat a colonoscopy in 1 year, 39 in 3 years, 30 in 5 years, 16 in 10 years. 5 required repeat colonoscopy due to an inadequate bowel prep. Presently, 11 completed further CRC screening. There have been 6 cases of interval CRC development among patients with discordant studies to date (5.8%). The median time from positive Cologuard test to CRC diagnosis was 838.2 days (SD 634.81).

Discussion: We observed a similar sensitivity (100%) and specificity (69%) when comparing our data to prior Cologuard studies supporting its use as a reliable screening test. Discordant results were present in 23% of this specific cohort. Our data suggests that providers may be hesitant to allow patients with discordant test results to go more than 3-5 years before next CRC surveillance test.



Disclosures:


Nicholas Talabiska, DO, Neil Mehta, MD, Shelby McNeilly, DO, Henry P Parkman, MD. P0341 - A Single Center Review of Patients With Discordant Cologuard Testing and Screening Colonoscopy: Who Are These Patients and What Is Being Recommended?, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.