The Practical Score for Predicting Colonic Polyps or Colorectal Cancer

Chollada Suwannachod

Authors

Chollada Suwannachod Department of Surgery, Pak Kret Hospital

Keywords:

Colonic polyp, CA colon, Colon cancer, CRC, Practical score

Abstract

Background: Early detection of colorectal neoplasia (adenomatous polyps and colorectal cancer; CRC) through the fecal immunochemical test (FIT) screening leads to increased colonoscopy referrals, causing delays in procedure because of limited colonoscopic capacity. Objective: This study aimed to develop a practical score for predicting of colorectal neoplasia in patients undergoing colonoscopy. Methods: This retrospective cohort study analyzed data from 345 patients who underwent colonoscopy by a single surgeon at Pak Kret Hospital, Thailand, between August 2017 and December 2024. Patients were divided into a normal group and a tumor group. Several clinical factors and laboratory results, including abdominal pain, change in bowel habit, bleeding per rectum, weight loss, anemia, family history of CRC, positive FIT result, and elevated CEA level, were collected and analyzed. A practical score was built using diagnostic weights, and its cut-off point was assessed at a ≥3. Results: Several symptoms and laboratory results showed statistically significant differences between the normal and tumor groups. The practical score at a cut-off of ≥3 points showed a sensitivity 78%, specificity 56%, PPV 40%, and NPV 87% for adenomatous polyps. For CRC, the sensitivity was 100%, specificity 56%, PPV 42%, and NPV 100%. Conclusion: This practical score, using available clinical and laboratory data, demonstrates good performance in identifying patients at higher risk of colorectal neoplasia, particularly CRC. A cut-off of 3 points effectively excluded CRC. This tool has the advantage to help in prioritizing patients for colonoscopy in resource-limited settings, colonoscopy scheduling and reducing diagnostic delays for high-risk patients.

References

National Cancer Institute, Ministry of Public Health. Guidelines for colorectal cancer screening, diagnosis and treatment (3rd revision). Nonthaburi: Ministry of Public Health; 2021.

Thai Association for Gastrointestinal Endoscopy [Internet]. [cited 2025 May 18]. Available from: https://www.gastrothai.net/th/knowledge-detail.php?content_id=347

Royal College of Surgeons of Thailand and Thai Society of Colorectal Surgeons. Dealing with colorectal diseases 2014. 1st ed. Bangkok: Bangkok Medical Publisher Limited Partnership; 2014.

Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M, et al. Genetic alterations during colorectal-tumor development. N Engl J Med 1988;319(9):525-32.

Holt TA, Virdee PS, Bankhead C, Patnick J, Nicholson BD, Fuller A, et al. Early detection of colorectal cancer using symptoms and the ColonFlag: case-control and cohort studies. NIHR Open Res 2023;3:6.

McCulloch SM, Aziz I, Polster AV, Pischel AB, Stålsmeden H, Shafazand M, et al. The diagnostic value of a change in bowel habit for colorectal cancer within different age groups. United European Gastroenterol J 2020;8(2):211-9.

Tong GX, Chai J, Cheng J, Xia Y, Feng R, Zhang L, et al. Diagnostic value of rectal bleeding in predicting colorectal cancer: a systematic review. Asian Pac J Cancer Prev 2014;15(2):1015-21.

Petre-Mandache CB, Margaritescu DN, Mitrut R, Kamal AM, Padureanu V, Cucu MG, et al. Risk factors and genetic predisposition in colorectal cancer: a study on young and old adults. Curr Health Sci J 2021;47(1):84-8.

Das V, Kalita J, Pal M. Predictive and prognostic biomarkers in colorectal cancer: A systematic review of recent advances and challenges. Biomed Pharmacother 2017;87:8-19.

Alvarado A. A practical score for the diagnosis of early acute appendicitis. Ann Emerg Med 1986;15(5):557-64.

Charoenkajonchai S, Sangkrajrang S, Dhamaraks S. Colorectal cancer screening of Thailand Public Health. Thai Cancer Journal 2022;42(2):86-103.

Aswakul P, Prachayakul V, Lohsiriwat V, Bunyaarunnate T, Kachintorn U. Screening colonoscopy from a large single center of Thailand - something needs to be changed? Asian Pac J Cancer Prev 2012;13(4):1361-4.

Lohsiriwat V, Chaisomboon N, Pattana-Arun J. Current colorectal cancer in Thailand. Ann Coloproctol 2020;36(2):78-82.

Kaneko H, Yano Y, Itoh H, Morita K, Kiriyama H, Kamon T, et al. Untreated hypertension and subsequent incidence of colorectal cancer: analysis of a nationwide epidemiological database. J Am Heart Assoc 2021;10(22):e022479.

Poprom N, Wilasrusmee C, Euanorasetr C, Suwanthanma W, Mongkolsomlit S. Development of scoring system for screening colorectal cancer: an alternative access to health care services. Rama Med J 2016;39(3):155-62.

Li W, Zhang L, Hao J, Wu Y, Lu D, Zhao H, et al. Validity of APCS score as a risk prediction score for advanced colorectal neoplasia in Chinese asymptomatic subjects: A prospective colonoscopy study. Medicine (Baltimore) 2016;95(41):e5123.

Erdem L, Akbal E, Koçak E, Tucer D, Üçbilek E, Uyanıkoğlu A, et al. A new risk-scoring system for colorectal cancer and polyp screening by Turkish Colorectal Cancer and Polyp Study Group. Turk J Gastroenterol 2022;33(4):286-93.