Application of metagenomic sequencing to improve sessile serrated lesion detection using the faecal immunochemical test

Shotgun metagenomics of FIT-preserved stool from 24 adults shows SSLs have a distinct microbial functional profile, including fewer KEGG orthologs and reduced polyamine biosynthesis capacity.

• Why it matters: FIT is effective for CRC screening but has low sensitivity for sessile serrated lesions, and FIT samples had not been used to characterize the SSL microbiome for biomarker discovery.
• What they did: The study reanalyzed paired FIT and fresh samples to test preservation, then sequenced FIT metagenomes from 24 adults (12 with clinically significant SSL, 12 NN) and compared them with a matched fresh-feces cohort.
• The result: Donor identity dominated compositional variance (63.5% vs 16.7%), collection method effects were small (6.3%–7.6%), and no single microbial feature was diagnostic, but a multi-feature signature may improve SSL detection in screening-collected samples.

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