Colonoscopy outcomes and clinical factors associated with significant findings in patients with positive fecal occult blood tests: A retrospective cohort study

Fecal occult blood test (FOBT) is widely used in colorectal cancer (CRC) screening; however, its ability to predict clinically significant pathology may vary across patient populations. This study aimed to evaluate colonoscopy outcomes in FOBT-positive patients and to identify clinical factors associated with clinically significant colonoscopic findings. This retrospective single-center cohort study included 216 adult patients with positive FOBT results who underwent colonoscopy between 2018 and 2024. Demographic characteristics, hemoglobin levels, FOBT methods, colonoscopic findings, and histopathological results were analyzed. Clinically significant pathology was defined as the presence of adenoma, advanced adenoma, CRC, or inflammatory lesions. Multivariable logistic regression analysis was performed to identify factors associated with clinically significant pathology, and receiver operating characteristic analysis was used to evaluate discriminative performance. Clinically significant pathology was detected in 57.4% of patients. The most frequent findings were adenomas (28.7%), advanced adenomas (14.8%), and CRC (8.3%). Older age (≥60 years), male sex, and anemia were significantly associated with clinically significant findings. Among these variables, anemia showed the strongest association with significant pathology. Receiver operating characteristic analysis demonstrated moderate discriminative ability for individual variables, whereas a combined model incorporating age, sex, and anemia achieved the highest performance (area under the curve = 0.81). FOBT positivity was associated with a high rate of clinically significant colonoscopic findings. Older age, male sex, and anemia may help identify higher-risk patients; however, these factors should not be used to exclude any FOBT-positive patient from colonoscopy. Prospective multicenter studies are needed to validate these findings.