Colonoscopy‐controlled intra‐individual comparisons to screen relevant neoplasia: faecal immunochemical test vs. guaiac‐based faecal occult blood test

Oort, Frank A.; Droste, Jochim S. Terhaar sive; Hulst, R. W. M. Van Der; Heukelem, H. A. van; Loffeld, R. J. L. F.; Wesdorp, I. C. E.; Wanrooij, Roy L.J. van; Baaij, Laura de; Mutsaers, E. R.; Reijt, S. Van Der; Coupé, Veerle M.H.; Berkhof, Johannes; Bouman, A.; Meijer, Gerrit A.; Mulder, Chris J.

doi:10.1111/j.1365-2036.2009.04184.x

Cited by 63 publications

(50 citation statements)

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“…14, 27). One should take into account, however, that these studies have been conducted in populations quite different from our study population, as both studies investigated symptomatic subjects with a higher mean age than our group (14,27). It is known that FITs carried out in symptomatic subjects yield higher sensitivities (28).…”

Section: Discussionmentioning

confidence: 87%

Test Performance of Immunologic Fecal Occult Blood Testing and Sigmoidoscopy Compared with Primary Colonoscopy Screening for Colorectal Advanced Adenomas

Bakker

Jonkers

Sanduleanu

et al. 2011

Cancer Prevention Research

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Given the current increase in colorectal cancer screening, information on performance of screening tests is needed, especially in groups with a presumed lower test performance. We compared test performance of immunologic fecal occult blood testing (FIT) and pseudosigmoidoscopy with colonoscopy for detection of advanced adenomas in an average risk screening population. In addition, we explored the influence of gender, age, and location on test performance. FIT was collected prior to colonoscopy with a 50 ng/mL cutoff point. FIT results and complete colonoscopy findings were available from 329 subjects (mean age: 54.6 AE 3.7 years, 58.4% women). Advanced adenomas were detected in 38 (11.6%) of 329 subjects. Sensitivity for advanced adenomas of FIT and sigmoidoscopy were 15.8% (95% CI: 6.0-31.3) and 73.7% (95% CI: 56.9-86.6), respectively. No sensitivity improvement was obtained using the combination of sigmoidoscopy and FIT. Mean fecal hemoglobin in FIT positives was significantly lower for participants with only proximal adenomas versus those with distal ones (P ¼ 0.008), for women versus men (P ¼ 0.023), and for younger (<55 years) versus older (!55 years) subjects (P ¼ 0.029). Sensitivities of FIT were 0.0% (95% CI: 0.0-30.9) in subjects with only proximal versus 21.4% (95% CI: 8.3-41.0) in those with distal nonadvanced adenomas; 5.3% (95% CI: 0.0-26.0) in women versus 26.3% (95% CI: 9.2-51.2) in men; 9.5% (95% CI: 1.2-30.4) in younger versus 23.5% (95% CI: 6.8-49.9) in older subjects. Sigmoidoscopy had a significantly higher sensitivity for advanced adenomas than FIT. A single FIT showed very low sensitivity, especially in subjects with only proximal nonadvanced adenomas, in women, and in younger subjects. This points to the existence of "low" FIT performance in subgroups and the need for more tailored screening strategies. Cancer Prev Res; 4(10); 1563-71. Ó2011 AACR.

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Section: Discussionmentioning

confidence: 87%

Test Performance of Immunologic Fecal Occult Blood Testing and Sigmoidoscopy Compared with Primary Colonoscopy Screening for Colorectal Advanced Adenomas

Bakker

Jonkers

Sanduleanu

et al. 2011

Cancer Prevention Research

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“…After initial screening of titles and abstracts, 113 papers were considered to be potentially relevant and ordered for full-paper screening; of these, 21 papers 13,[52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71] were included in the review.…”

Section: Results Of the Assessment Of Clinical Effectiveness Assessmentmentioning

confidence: 99%

“…Five diagnostic cohort studies, 13,52,53,55,58 reported in 17 publications, 13,52,53,55,[58][59][60][61][62][63][64][67][68][69][70]73,74 provided data on the diagnostic performance of the OC-Sensor FIT assay. All five studies 13,52,53,55,58 reported accuracy data, for which CRC was the specified target condition, 13 53,55 Three studies reported additional accuracy data various non-malignant and composite target conditions.…”

Section: Details Of Oc-sensor Studiesmentioning

confidence: 99%

Faecal immunochemical tests to triage patients with lower abdominal symptoms for suspected colorectal cancer referrals in primary care: a systematic review and cost-effectiveness analysis

Westwood

Ramos

Lang

et al. 2017

Health Technol Assess

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BackgroundColorectal cancer (CRC) is the third most common cancer in the UK. Presenting symptoms that can be associated with CRC usually have another explanation. Faecal immunochemical tests (FITs) detect blood that is not visible to the naked eye and may help to select patients who are likely to benefit from further investigation.ObjectivesTo assess the effectiveness of FITs [OC-Sensor (Eiken Chemical Co./MAST Diagnostics, Tokyo, Japan), HM-JACKarc (Kyowa Medex/Alpha Laboratories Ltd, Tokyo, Japan), FOB Gold (Sentinel/Sysmex, Sentinel Diagnostics, Milan, Italy), RIDASCREEN Hb or RIDASCREEN Hb/Hp complex (R-Biopharm, Darmstadt, Germany)] for primary care triage of people with low-risk symptoms.MethodsTwenty-four resources were searched to March 2016. Review methods followed published guidelines. Summary estimates were calculated using a bivariate model or a random-effects logistic regression model. The cost-effectiveness analysis considered long-term costs and quality-adjusted life-years (QALYs) that were associated with different faecal occult blood tests and direct colonoscopy referral. Modelling comprised a diagnostic decision model, a Markov model for long-term costs and QALYs that were associated with CRC treatment and progression, and a Markov model for QALYs that were associated with no CRC.ResultsWe included 10 studies. Using a single sample and 10 µg Hb/g faeces threshold, sensitivity estimates for OC-Sensor [92.1%, 95% confidence interval (CI) 86.9% to 95.3%] and HM-JACKarc (100%, 95% CI 71.5% to 100%) indicated that both may be useful to rule out CRC. Specificity estimates were 85.8% (95% CI 78.3% to 91.0%) and 76.6% (95% CI 72.6% to 80.3%). Triage using FITs could rule out CRC and avoid colonoscopy in approximately 75% of symptomatic patients. Data from our systematic review suggest that 22.5–93% of patients with a positive FIT and no CRC have other significant bowel pathologies. The results of the base-case analysis suggested minimal difference in QALYs between all of the strategies; no triage (referral straight to colonoscopy) is the most expensive. Faecal immunochemical testing was cost-effective (cheaper and more, or only slightly less, effective) compared with no triage. Faecal immunochemical testing was more effective and costly than guaiac faecal occult blood testing, but remained cost-effective at a threshold incremental cost-effectiveness ratio of £30,000. The results of scenario analyses did not differ substantively from the base-case. Results were better for faecal immunochemical testing when accuracy of the guaiac faecal occult blood test (gFOBT) was based on studies that were more representative of the correct population.LimitationsOnly one included study evaluated faecal immunochemical testing in primary care; however, all of the other studies evaluated faecal immunochemical testing at the point of referral. Further, validation data for the Faecal haemoglobin, Age and Sex Test (FAST) score, which includes faecal immunochemical testing, showed no significant difference in performance between primary and secondary care. There were insufficient data to adequately assess FOB Gold, RIDASCREEN Hb or RIDASCREEN Hb/Hp complex. No study compared FIT assays, or FIT assays versus gFOBT; all of the data included in this assessment refer to the clinical effectiveness of individual FIT methods andnottheir comparative effectiveness.ConclusionsFaecal immunochemical testing is likely to be a clinically effective and cost-effective strategy for triaging people who are presenting, in primary care settings, with lower abdominal symptoms and who are at low risk for CRC. Further research is required to confirm the effectiveness of faecal immunochemical testing in primary care practice and to compare the performance of different FIT assays.Study registrationThis study is registered as PROSPERO CRD42016037723.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Between 70% and 90% of CRC originates from adenomatous polyps, and early detection and removal of these precancerous adenomas significantly decrease CRC incidence and mortality [43]. Therefore, current CRC screening aims for early detection of CRC, and those adenomas with a high risk of malignant transformation (advanced adenomas) [44]. In screening tests, individuals with a positive fecal immunological test (FIT) are referred for colonoscopy (gold standard).…”

Section: Colorectal Cancermentioning

confidence: 99%

Application of Fecal Volatile Organic Compound Analysis in Clinical Practice: Current State and Future Perspectives

et al. 2018

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Abstract:Increasing interest is noticed in the potential of volatile organic compound (VOC) analysis as non-invasive diagnostic biomarker in clinical medical practice. The spectrum of VOCs, originating from (patho)physiological metabolic processes in the human body and detectable in bodily excrements, such as exhaled breath, urine and feces, harbors a magnificent source of information. Thus far, the majority of studies have focused on VOC analysis in exhaled breath, aiming at identification of disease-specific VOC profiles. Recently, an increasing number of studies have evaluated the usability of VOC present in the headspace of feces in the diagnostic work-up of a wide range of gastrointestinal diseases. Promising results have been demonstrated particularly in those diseases in which microbiota alterations are considered to play a significant etiological role, such as colorectal carcinoma, inflammatory bowel disease, irritable bowel syndrome, celiac disease and infectious bowel diseases. In addition, fecal VOC analysis seems to have potential as a diagnostic biomarker for extra-intestinal diseases, including bronchopulmonary dysplasia and sepsis. Different methods for VOC analysis have been used in medical studies, such as gas-chromatography mass spectrometry, selected-ion flow tube-mass spectrometry, ion-mobility spectrometry, and electronic nose devices. In this review, the available literature on the potential of fecal VOCs as diagnostic biomarker, including an overview of relevant VOC detection techniques, is discussed. In addition, future hurdles, which need to be taken prior to implementation of VOC analysis in daily clinical practice, are outlined.

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Colonoscopy‐controlled intra‐individual comparisons to screen relevant neoplasia: faecal immunochemical test vs. guaiac‐based faecal occult blood test

Abstract: SUMMARY BackgroundGuaiac-based faecal occult blood tests (g-FOBTs) are most commonly used in colorectal cancer (CRC) screening programmes. Faecal immunochemical tests (FITs) are thought to be superior.

Cited by 63 publications

References 33 publications

Test Performance of Immunologic Fecal Occult Blood Testing and Sigmoidoscopy Compared with Primary Colonoscopy Screening for Colorectal Advanced Adenomas

Test Performance of Immunologic Fecal Occult Blood Testing and Sigmoidoscopy Compared with Primary Colonoscopy Screening for Colorectal Advanced Adenomas

Faecal immunochemical tests to triage patients with lower abdominal symptoms for suspected colorectal cancer referrals in primary care: a systematic review and cost-effectiveness analysis

Application of Fecal Volatile Organic Compound Analysis in Clinical Practice: Current State and Future Perspectives

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