Background and aims: This prospective trial was designed to compare the performance characteristics of five different screening tests in parallel for the detection of advanced colonic neoplasia: CT colonography (CTC), colonoscopy (OC), flexible sigmoidoscopy (FS), faecal immunochemical stool testing (FIT) and faecal occult blood testing (FOBT). Methods: Average risk adults provided stool specimens for FOBT and FIT, and underwent same-day low-dose 64-multidetector row CTC and OC using segmentally unblinded OC as the standard of reference. Sensitivities and specificities were calculated for each single test, and for combinations of FS and stool tests. CTC radiation exposure was measured, and patient comfort levels and preferences were assessed by questionnaire. Results: 221 adenomas were detected in 307 subjects who completed CTC (mean radiation dose, 4.5 mSv) and OC; 269 patients provided stool samples for both FOBT and FIT. Sensitivities of OC, CTC, FS, FIT and FOBT for advanced colonic neoplasia were 100% (95% CI 88.4% to 100%), 96.7% (82.8% to 99.9%), 83.3% (95% CI 65.3% to 94.4%), 32% (95% CI 14.9% to 53.5) and 20% (95% CI 6.8% to 40.7%), respectively. Combination of FS with FOBT or FIT led to no relevant increase in sensitivity. 12 of 45 advanced adenomas were smaller than 10 mm. 46% of patients preferred CTC and 37% preferred OC (p,0.001). Conclusions: High-resolution and low-dose CTC is feasible for colorectal cancer screening and reaches sensitivities comparable with OC for polyps .5 mm. For patients who refuse full bowel preparation and OC or CTC, FS should be preferred over stool tests. However, in cases where stool tests are performed, FIT should be recommended rather than FOBT.Colorectal cancer is one of the major public health issues in industrialised countries. Most colorectal cancers are thought to originate from benign adenomatous polyps that develop over a period of many years.1 Early detection followed by removal of adenomas has been shown to reduce incidence and colorectal cancer-related mortality.2 3Therefore, screening of the asymptomatic and average risk population is recommended by many organisations and expert panels, and is reimbursed by insurance companies in several countries. 4-7Next to colonoscopy, flexible sigmoidoscopy (FS) and guaiac-based faecal occult blood test (FOBT) are widely applied screening procedures which have been compared prospectively with each other. Colonoscopy has been found to be the screening test with the highest sensitivity and outperforms FS and FOBT which miss a significant number of relevant adenomas. 8 Colonoscopy, however, is not a perfect test in itself, and misses 6-12% of large adenomas. 9-11CT colonography (CTC), also known as virtual colonoscopy, and faecal immunochemical tests (FITs) have been proposed as screening tests for colonic neoplasia.12-14 They have at present not been integrated into screening programmes. Based on recent research, CTC shows heterogeneous results in the detection of colonic polyps: some studies demonstrated high sen...

In comparison with dietary measures alone, the combination of a low-cholesterol diet and simvastatin after heart transplantation led to a significant reduction in cholesterol levels, a significantly higher long-term survival rate, and a lower incidence of GVD.

To the best of our knowledge, this is the most comprehensive side-by-side comparison of five current top of the range routine hematology analyzers. Variable analyzer quality and parameter specific limitations must be considered in defining laboratory algorithms in clinical practice.

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ObjectiveFaecal calprotectin is used as a sensitive marker for gastrointestinal mucosal inflammation. We compared the performance of three different assays in a large cohort of symptomatic paediatric patients.DesignRetrospective monocentric study.SettingInpatients and outpatients of a tertiary referral centre for paediatric gastroenterology.Participants304 symptomatic patients (163 males, aged 2–20 years) with active inflammatory bowel disease (IBD/A, n=130), IBD in clinical remission (IBD/R, n=62), other intestinal diseases (n=45) and controls without identified intestinal disease (n=67).InterventionsCalprotectin was measured in homogenised faecal samples with three tests (A: EliA Calprotectin, Phadia AB, Sweden; B: PhiCal, Calpro AS, Norway; C: EK-Cal, Bühlmann Laboratories, Switzerland).OutcomesConcordance between tests was calculated using Kendall's τ coefficient.ResultsIBD/A and controls were correctly classified as 97.7%/82.1% (A), 97.7%/85.1% (B) and 98.4%/62.7% (C; not significant). Test C tended to have higher calprotectin values with a lower specificity compared to tests A and B. The concordance between two tests was 0.835 for tests A and B, 0.782 for tests A and C and 0.765 for tests B and C.ConclusionsAll three tests are very sensitive for detecting mucosal inflammation, but major differences exist between specificity and absolute values. It is highly advisable to use the test of the same manufacturer for follow-up and to monitor for disease activity.