Histopathological Spectrum in FIT‐Positive Patients With Abnormal Colonoscopy Findings at a Tertiary Medical Center in Lebanon: A Retrospective Observational Study

ABSTRACT Background and Aims Colorectal cancer is a leading cause of cancer‐related morbidity and mortality, and the prognosis significantly depends on the diagnostic stage. Various screening initiatives have been established, among which the fecal immunochemical test (FIT) (FITFIT) which is prominent for its affordability, non‐invasive approach, and wide acceptance. This study aimed to describe the spectrum of histopathological findings among patients with positive fecal occult blood test and abnormal colonoscopy findings, and to identify associated risk factors. Methods This retrospective observational study included 172 adults with documented positive FIT and abnormal colonoscopy findings at Makassed General Hospital from January 2024 to December 2025. Statistical analysis was conducted using SPSS version 25, and associations were assessed using chi‐square or Fisher's exact tests, with significance defined as p < 0.05. Results A total of 172 patients were included, with a mean age of 63.88 ± 11.79 years, and 55.2% were female. The most frequently recorded indications for colonoscopy were anemia (39%) and screening (37.2%). Polyps were the most common colonoscopy finding. Histopathological examination demonstrated that neoplastic polyps represented the predominant diagnosis (65.1%), followed by non‐neoplastic lesions (24.4%) and malignancy (10.5%). Patients aged 45 years and older demonstrated a higher prevalence of polyps on colonoscopy; however, the difference did not reach statistical significance. No significant association was observed between gender and colonoscopy or histopathological findings. Abdominal pain and diarrhea were both significantly associated with non‐neoplastic histopathological lesions. Conclusion Among patients with positive FIT and abnormal colonoscopy findings, neoplastic polyps rather than malignancy represented the predominant histopathological findings, supporting the clinical utility of FIT in detecting clinically important colorectal lesions at earlier stages. In addition, variability in the histopathology depending on the clinical presentation may contribute to clinical assessment and risk stratification. Larger prospective studies are needed to determine predictors of advanced colorectal histopathology.