Detection of adenoma, serrated lesion, and colorectal cancer in Lynch syndrome: a systematic review and meta-analysis.
Stephanie Xiu Wern Poo, Nick Dai, Amanda J Cross et al.
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In 30 seconds
This systematic review and meta-analysis assessed colorectal neoplasia detection and associated factors in people with Lynch syndrome. Across 36 studies, 45 421 colonoscopies in 15 227 carriers yielded pooled detection rates of 23.3% for adenoma, 5.3% for advanced adenoma, 8.6% for serrated lesions, and 2.5% for colorectal cancer. Detection varied with study and procedure quality: adenoma detection was highest in trial populations excluding poor-quality or incomplete procedures (30.7%), compared with 24.0% in prospective and 18.5% in retrospective observational studies. Advanced neoplasia rates were higher in MLH1/MSH2 than MSH6/PMS2 carriers.
Key findings
- Pooled detection rates were 23.3% for adenoma, 5.3% for advanced adenoma, 8.6% for serrated lesions, and 2.5% for colorectal cancer.
- Adenoma detection was 30.7% in trial populations excluding poor-quality or incomplete procedures, versus 24.0% in prospective and 18.5% in retrospective studies.
- Adenoma detection was higher proximally than distally (16.4% vs. 11.9%); flat adenomas accounted for a 16.1% detection rate.
- Advanced neoplasia rates were generally higher in MLH1/MSH2 than MSH6/PMS2 carriers.
Why it matters
The pooled estimates provide a reference for interpreting colorectal neoplasia detection in Lynch syndrome, while the variation by procedure quality and genotype highlights that detection rates are not uniform. The findings also identify gaps in reporting: completion and bowel preparation data were available for only a minority of procedures, limiting assessment of colonoscopy quality across the evidence base.
What to keep in mind
The review found inconsistent reporting of quality metrics; completion and bowel preparation data were available for only 36.7% and 30.0% of procedures, respectively.