A Comparison of Fecal Occult-Blood Tests for Colorectal-Cancer Screening

Allison, James E.; Tekawa, Irene S.; Ransom, Laura J.; Adrain, Alyn L.

doi:10.1056/nejm199601183340304

Cited by 559 publications

(366 citation statements)

References 16 publications

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“…8 A factor driving increased colonoscopic use is that advanced colonic neoplasms may be missed by a 1-time GFOBT screen. One-time sensitivity of the original GFOBT Hemoccult II (Beckman Coulter, Fullerton, California) for cancer appears to be less than 50% 13 and perhaps even lower. 14 Another study observed that 24% of advanced neoplasms are missed by 1-time GFOBT plus flexible sigmoidoscopy.…”

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confidence: 95%

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Comparison of a brush‐sampling fecal immunochemical test for hemoglobin with a sensitive guaiac‐based fecal occult blood test in detection of colorectal neoplasia

Smith

Young

Cole

et al. 2006

Cancer

144

125

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In this article, the effect of sample size on the degassing behavior of closed‐cell low density polyethylene (LDPE) foam under long‐term compressive static loading is presented. The creep response was modeled by assuming isothermal compression of the gas. The change in gas pressure with time was obtained and the effective diffusion coefficients were calculated from pressure decrease using an analytical solution of the diffusion equation, and were found to increase when the sample size was reduced. © 2005 Wiley Periodicals, Inc. J Appl Polym Sci, 2006

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“…12 To improve sensitivity of GFOBT, rehydration has been used, 3 and newer GFOBT have been specifically designed to be more sensitive and readable. 13,15,16,17 The logistics of performing GFOBTs also lead to questions concerning their usefulness. 1,16 GFOBTs detect peroxidase activity of heme in feces.…”

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confidence: 99%

Comparison of a brush‐sampling fecal immunochemical test for hemoglobin with a sensitive guaiac‐based fecal occult blood test in detection of colorectal neoplasia

Smith

Young

Cole

et al. 2006

Cancer

144

125

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Section: Sirmentioning

confidence: 99%

“…This is particularly relevant when other better options are available for stool testing for CRC namely IFOBT (Allison et al, 1996;Morikawa et al, 2005) and should have been discussed by the authors. These ELISAbased IFOBTs (Allison et al, 1996) or automatically analysable IFOBT (Morikawa et al, 2005) have demonstrated sensitivity of around 60% and specificity of about 90%. Recently various 'office based or bedside' simple, convenient and cheap strip-based IFOBT have been validated for CRC screening with performance characteristics similar to that of an ELISA-based IFOBT (Hoepffner et al, 2006;Smith et al, 2006).…”

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New faecal tests for colorectal cancer screening: is tumour pyruvate kinase M2 one of the options?

Shastri

Stein

2007

Br J Cancer

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Cancer Research UK Sir,We read with great interest the article by Haug et al (2007) and must complement them for a nicely written work. We have certain comments to make about their study.Colorectal adenomas, the precursors of almost all of the sporadic colorectal cancer (CRC) could not be included in their study. The ability of various CRC screening programme (eg, colonoscopy) in reducing CRC mortality by diagnosing and removing these premalignant lesions cannot be overemphasised. It is agreed that the false positives due to these adenomas in the control group would have contributed to marginal increase in the specificity of faecal pyruvate kinase type M2 (M2-PK) in their study (Haug et al, 2007), as rightly mentioned by the authors.But what about the adenomas that could have been missed out by performing M2-PK assay in the controls? The prevalence of any adenomatous lesion in their control group would have been somewhere around 30% and roughly 8% would have been advanced adenomas (Anderson et al, 2003), usually described as villous adenomas, tubular adenomas 410 mm, high-grade dysplasia, malignant polyp or 43 adenomas (ie, around 73 out of these 917 control group patients (Haug et al, 2007)). The previous studies have reported sensitivity of M2-PK to be just 30% in diagnosing advanced adenomas and 40% by Koss et al (2005) (only as an abstract). Thus, assuming that a sensitivity of around 35% for diagnosing these advanced adenomas from the above two studies would be applied to the population studied, then there would be a marked decrease in the resulting sensitivity of M2-PK for diagnosing colorectal neoplasia (CRN), that is CRC with advanced adenomas. Thus, the estimated sensitivity of M2-PK in diagnosing CRN would decrease to 48% (26 þ 45/73 þ 74) as against 67% (45/74) reported in this study (Haug et al, 2007). This would be highly unacceptable for any CRC screening test and especially for M2-PK with such a poor specificity of around 80%, which is much lower than that of any of the faecal screening tests for CRC, in fact even lower than that of Guaiac-based faecal occult blood test (FOBTs).One of the limitations of their study was a retrospective study design with historical controls; these subjects did not undergo either any of the more accurate faecal screening test, for example, IFOBT (immunological FOBT) or a colonoscopy for confirming the results of M2-PK in detecting CRC. Thus, if the prevalence of CRC is taken to be 1% in the historical controls, there lies a possibility of missing out significant number of CRC in the control group considering such a low performance characteristics which is highly unacceptable.We agree with the authors that the poor performance characteristics (especially low specificity and poor PPV) of faecal tumour M2-pyruvate kinase (M2-PK) as has also been reported in previous prospective study does not warrant its use as a marker for CRC screening. This is particularly relevant when other better options are available for stool testing for CRC namely IFOBT (Allison et al, 1996;M...

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“…To screen for colorectal diseases, immunological fecal occult blood tests using fecal hemoglobin (Hb) as a marker are widely performed (1)(2)(3)(4). However, Hb is unstable in feces, leading to false-negative results, and this test is of no use for the detection of lesions without bleeding.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Tests for Fecal Lactoferrin and Fecal Occult Blood for Colorectal Diseases. A Prospective Pilot Study.

et al. 2000

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Objective This prospective pilot study was conducted to compare the usefulness of measuring fecal lactoferrin (LI) to that of fecal occult blood (FOB) test for detection of colorectal diseases. Patients and Methods The subjects were 351 patients whounderwentcolonoscopy. Afecal sample was obtained on the day before colonoscopy. Fecal Lf was measured by enzyme-linked immunosorbent assay. The FOBtest was performed by combined assay (latex agglutination) of hemoglobinand transferrin. Results The specificities of the fecal Lf and FOBtests were the same (88.7 %). For patients with colorectal cancer (13), colorectal polyp (69), ulcerative colitis (18), Crohn' s disease (13), non-specific colitis (8), internal hemorrhoids (60), colon diverticulum (27), and miscellaneous diseases of the colon (10), the rates of positivity for fecal Lf were II 13, 14/69, 12/18, 7/13, 4/8, 22/60, 8/27, and 6/10, respectively. The corresponding rates for FOB were 8/13, 12/69, ll/18, 4/13, 4/8, 9/60, 2/27, and 1/10. For patients with internal hemorrhoids, the rate of positivity for fecal Lf was significantly higher than that for FOB. In other disease groups, there was no significant difference in the rate of positivity between fecal Lf and FOB. Conclusion These findings suggest that measurement of fecal Lf is as useful as FOBin detecting colorectal diseases. (Internal Medicine 39: 778-782, 2000)

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A Comparison of Fecal Occult-Blood Tests for Colorectal-Cancer Screening

Abstract: HemeSelect and a combination test in which HemeSelect is used to confirm positive Hemoccult II Sensa results improve on Hemoccult II in screening patients for colorectal carcinoma.

Cited by 559 publications

References 16 publications

Comparison of a brush‐sampling fecal immunochemical test for hemoglobin with a sensitive guaiac‐based fecal occult blood test in detection of colorectal neoplasia

Comparison of a brush‐sampling fecal immunochemical test for hemoglobin with a sensitive guaiac‐based fecal occult blood test in detection of colorectal neoplasia

New faecal tests for colorectal cancer screening: is tumour pyruvate kinase M2 one of the options?

Comparison of Tests for Fecal Lactoferrin and Fecal Occult Blood for Colorectal Diseases. A Prospective Pilot Study.

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