Abstract
Validation of Modified Asia-Pacific Colorectal Screening Score for Risk Prediction of Advanced Colorectal Neoplasia Among Filipino Adults
Ferdinand M. Anzo, MD; Sarah Jean C. Bellido, MD
St. Luke’s Medical Center – Quezon City
Significance: Colon cancer is the fourth leading cause of cancer-related deaths in the Philippines, particularly affecting individuals aged 50 and above. Colonoscopy remains the gold standard for screening, but in resource-limited areas, a risk scoring system may help prioritize individuals who need further evaluation. This study aims to validate the Modified Asia-Pacific Colorectal Screening (APCS) score in predicting the risk of advanced colorectal neoplasia among asymptomatic Filipino adults.
Methodology: This prospective study included 391 asymptomatic adult patients, aged 45-75, who underwent screening colonoscopy at St. Luke’s Medical Center. Patients with prior colorectal procedures or diseases were excluded. The Modified APCS score, based on factors such as age, sex, body mass index (BMI), family history, and smoking history, was used to assess the risk of advanced colorectal neoplasia. Colonoscopy and histopathological findings were collected, and the study calculated the sensitivity, specificity, and predictive values of the Modified APCS score.
Results: A total of 391 patients were included in the study, with the majority aged 55-64 years and a higher proportion of females. The most common lesions were tubular adenomas smaller than 10 mm (36.6%), followed by tubulovillous adenomas (3.6%), with a higher prevalence in males and those with a BMI over 23 kg/m2. The Modified APCS score, using a cutoff of >3, demonstrated 75% sensitivity (CI: 53.29% to 90.23%) but low specificity (33.24%, CI: 28.44% to 38.32%), suggesting it may be effective at ruling out advanced neoplasia but less reliable in identifying true positives. The score performed differently based on age: it had higher sensitivity in patients 50 years old and above (75%) and greater specificity in those under 50 (54.69%), with both age groups showing high negative predictive value (NPV) of 95.31% (CI: 90.92% to 97.63%), but low positive predictive value (PPV). These findings suggest that the modified APCS score may have utility in ruling out advanced colorectal neoplasia.
Conclusion: The modified APCS score may have limited applicability in asymptomatic adult Filipinos due to its low specificity and PPV, reducing its ability to accurately predict advanced colorectal neoplasia. However, its high sensitivity and NPV make it useful for identifying low-risk individuals, helping to prioritize higher-risk patients for further evaluation.
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |