ArticleTranslational oncology2026
Colonoscope-derived mucus as a novel high-fidelity reservoir for KRAS-mutated precancerous colorectal neoplasia detection.
Article in Translational oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
aimsCurrent colorectal cancer (CRC) screening methods have limited sensitivity for precancerous lesions. Blood-based liquid biopsies are constrained by systemic dilution, highlighting the need for localized, minimally invasive molecular approaches. We evaluated whether colonoscope-derived mucus serves as a high-fidelity source of cell-free DNA (cfDNA) for detecting KRAS-mutated colorectal neoplasia.
methodsIn this prospective pilot study, mucus samples (N = 43) were collected from the colonoscope sheath during routine colonoscopy. cfDNA was analyzed for KRAS codon 12 mutations using a competitive PCR assay. Diagnostic performance at variant allele frequency (VAF) thresholds (>1% and >0.1%) was compared with histology, fecal immunochemical testing (FIT), and carcinoembryonic antigen (CEA).
resultsAt VAF >0.1%, mucus cfDNA achieved 80.0% sensitivity for colorectal neoplasia, outperforming FIT (40.0%) and CEA (10.0%, p = 0.005). Sensitivity reached 100% for adenocarcinoma (n=2) and 75.0% for advanced precancerous colorectal lesions. Specificity decreased to 29.6% at lower thresholds, likely due to inflammatory confounders. Importantly, KRAS mutations were detected in visually inconspicuous mucosa.
conclusionsColonoscope-derived mucus is a promising localized cfDNA source for detecting early colorectal neoplasia. This approach may serve as a colonoscopy-integrated adjunct within existing screening pathways and may support post-procedure risk stratification and surveillance optimization.
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