New scoring system combining fecal SDC2 methylation testing with clinical risk factors improves detection of advanced adenomas with higher specificity.
A new diagnostic approach combining fecal syndecan-2 (SDC2) methylation testing with clinical risk assessment demonstrates improved performance for detecting colorectal adenomas compared to traditional screening methods, according to a multicenter study published in Cancer Screening and Prevention.
The APCS-SDC2 scoring system integrates fecal SDC2 methylation results with the Asia-Pacific Colorectal Screening (APCS) scoring system to enhance risk stratification for advanced adenomas. In the study of 985 participants, the combined approach showed superior discriminatory performance with an area under the curve of 0.7032 and significantly higher specificity than the APCS score alone (86.7% vs 66.7%).
“Among individuals with positive fecal SDC2 methylation test results, the detection rates of advanced adenomas were significantly elevated, and colonoscopy should be prioritized,” the researchers conclude.
Study Design and Performance Metrics
The prospective, multicenter diagnostic study enrolled adult participants with no history of colonoscopy within the past three years. All participants underwent fecal SDC2 methylation testing and colonoscopy, with colonoscopy outcomes and pathological results serving as reference standards.
Of the 985 participants, 62 (6.3%) tested positive for fecal SDC2 methylation. The test demonstrated a sensitivity of 31.3% (95% confidence interval: 21.6-42.7%) and specificity of 96.1% (95% confidence interval: 94.6-97.2%) for detecting advanced adenomas.
The APCS-SDC2 scoring system was developed using 632 randomly selected samples, with ordered logistic regression and bootstrap optimism correction applied to assess predictor variables and assign corresponding scores. A validation cohort of 316 samples was used to validate the model’s performance.
Clinical Implementation Implications
The fecal SDC2 methylation test and reference standard assessments were conducted in a blinded manner to ensure objective evaluation. The study found that the APCS-SDC2 scoring system demonstrated superior risk stratification performance for advanced adenomas compared with the APCS scoring system alone.
The research adds to accumulating evidence that fecal SDC2 methylation serves as a promising biomarker for early detection of colorectal cancer. The methylation-based approach offers a non-invasive screening option that could complement existing colorectal cancer screening protocols.
The higher specificity of the combined scoring system could potentially reduce unnecessary colonoscopies while maintaining effective detection of clinically significant lesions, though further validation studies may be needed to establish clinical implementation guidelines.
ID 109967042 © Shao-chun Wang | Dreamstime.com
