An invited review following the Soujinkai Young Investigator Award:Multitarget Stool Test for Detecting Advanced Colorectal Adenomas

The fecal immunochemical test for hemoglobin (FIT) is widely used for colorectal cancer screening but shows limited sensitivity for detecting advanced colorectal adenomas. To overcome this limitation, we evaluated a combined approach using FIT and fecal DNA testing for methylated somatostatin (SST). Fecal samples were collected from healthy subjects, patients with non-advanced adenoma, advanced adenoma, and colorectal cancer. SST methylation levels were quantified using droplet digital PCR after treatment with methylation-sensitive restriction enzymes. Using logistic multivariate analysis, we developed the FAMS (FIT, age, methylated SST) index. The FAMS index improved sensitivity for detecting advanced adenoma compared with FIT alone while maintaining high specificity. Even at higher specificity, the sensitivity of the FAMS index remained higher than that of FIT. These results suggest that the FAMS index can non-invasively enhance early detection of advanced colorectal adenoma and may serve as a promising tool for screening.