Diagnostic Accuracy of a Qualitative Fecal Immunochemical Test Varies With Location of Neoplasia But Not Number of Specimens

Wong, Martin Cs; Ching, Jessica; Chan, Victor; Lam, Thomas Y.; Shum, Jeffrey P.; Luk, Arthur K.C.; Wong, S.P.; Ng, Siew C.; Ng, Simon Siu Man; Wu, Justin C.Y.; Chan, Francis K.L.; Sung, Joseph J.Y.

doi:10.1016/j.cgh.2015.02.021

Cited by 55 publications

(56 citation statements)

References 29 publications

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“…A number of studies have addressed site specific sensitivity of FITs, and most of them found somewhat lower sensitivity for proximal compared to distal neoplasms . Typically, however, no further distinction according to subsite within the proximal colon or distal colon and rectum was made.…”

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confidence: 99%

“…Typically, however, no further distinction according to subsite within the proximal colon or distal colon and rectum was made. Also, results were rather heterogeneous, as were the definitions of site and types of neoplasms and of the subgroups of patients for which site specific sensitivity was determined: In some studies, sensitivity for detecting proximal neoplasms was determined irrespective of the presence of distal neoplasms (or vice versa) . This approach reflects the proportion of carriers of proximal neoplasms that would be expected to have a positive FIT result in practice, even though some of the positive FIT results may be due to bleeding of a distal neoplasm.…”

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confidence: 99%

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Strong subsite‐specific variation in detecting advanced adenomas by fecal immunochemical testing for hemoglobin

Brenner

Niedermaier

Chen

2017

Intl Journal of Cancer

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Fecal immunochemical tests (FITs) for hemoglobin are increasingly recommended and used in colorectal cancer (CRC) screening. We aimed to provide a detailed assessment of the sensitivity of FIT according to type and subsite of neoplasms in a true screening setting. A quantitative FIT (FOB Gold, Sentinel Diagnostics, Milano, Italy) was applied prior to colonoscopy by 3,466 participants of the German screening colonoscopy program. Subsite specific sensitivity for various types of colorectal neoplasms was derived by comparing FIT results with findings at screening colonoscopy. The most advanced finding at colonoscopy was CRC, advanced adenoma, and nonadvanced adenoma in 29, 354 and 686 cases, respectively. Per-adenoma sensitivity for large advanced adenomas (>1 cm) strongly varied by location (p < 0.001): cecum: 0/14 (0%), ascending colon and right flexure: 11/43 (26%), transverse colon and left flexure: 2/14 (14%), descending colon: 7/12 (58%), sigmoid colon: 47/92 (51%), rectum: 14/39 (36%). By contrast, the FIT detected all of 5 proximal CRC and 23 out of 24 (96%) distal CRCs, whereas per-adenoma sensitivity of both proximal (17/259, 7%) and distal nonadvanced adenomas (20/237, 8%) essentially equaled the false positivity rate among those without neoplasms (152/2,397, 6%). In conclusion, we found a very large gradient of subsite specific FIT sensitivity for detecting large advanced adenomas ranging from 0% for advanced adenomas located in the cecum to >50% for those located in the descending or sigmoid colon. By contrast, FIT sensitivity was uniformly excellent for CRC and uniformly poor for nonadvanced adenomas, regardless of their location.

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confidence: 99%

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confidence: 99%

Strong subsite‐specific variation in detecting advanced adenomas by fecal immunochemical testing for hemoglobin

Brenner

Niedermaier

Chen

2017

Intl Journal of Cancer

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“…For instance, the reduction of mortality due to colonoscopy was based on an observational study, 27 and studies in the United States, Canada, and Germany suggested that the reduction in mortality or incidence were almost entirely in the right colon. Furthermore, more conservative screening strategies may refer only 3% to 7% of patients with advanced distal neoplasia at index FS for colonoscopy follow-up, 44 and even lower proportions in subsequent FS screening tests. Another example is that a certain proportion of cancer polyps might only be treated with endoscopy but not surgery, and this may bear implications on the cost estimates.…”

Section: Discussionmentioning

confidence: 99%

Colorectal Cancer Screening Based on Age and Gender

et al. 2016

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“…The test performance of FIT may be affected by the prevalence of CRC in the population of interest [20], the site of the lesion within the colon [18], the size of the lesion [21], the FIT brand [22], the time from collection to analysis [23], the interval between screening rounds [24], the cut-off chosen for positivity, and the number of specimens collected per screening round [25]. …”

Section: Discussionmentioning

confidence: 99%

“…In theory, CRCs bleed intermittently; however, there are limited and contradictory data available assessing the effect of the number of FIT specimens per screening round [17, 18]. Additionally, increased resources are required for multiple samples, and the cost-effectiveness of this approach is not clear.…”

Section: Introductionmentioning

confidence: 99%

Comparison of One versus Two Fecal Immunochemical Tests in the Detection of Colorectal Neoplasia in a Population-Based Colorectal Cancer Screening Program

Moosavi

Enns

Gentile

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

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Objective. To determine the positive predictive value (PPV) of two versus one abnormal FIT in the detection of colorectal neoplasia in a Canadian population. Methods. Three communities enrolled in a colorectal cancer (CRC) screening pilot program from 01/2009 to 04/2013 using 2 FITs. Data collected included demographics, colonoscopy, pathology, and FIT results. Participants completed both FITs and had one positive FIT and colonoscopy. PPV of one versus two abnormal FITs was calculated using a weighted-generalized score statistic. A two-sided 5% significance level was used. Results. 1576 of 17,031 average-risk participants, 50–75 years old, had a positive FIT. Colonoscopy revealed 58 (3.7%) cancers, 419 (31.6%) high-risk polyps, and 374 (23.7%) low-risk polyps as the most significant lesion. PPV of one versus two positive FITs for cancer, high-risk polyps, and any neoplasia were 1% versus 8%, 20% versus 40%, and 48% versus 67%, respectively (p value < 0.0001). When the first FIT was negative, the second positive FIT detected 7 CRCs and 98 high-risk polyps. Conclusions. PPV of two positive FITs is superior to one positive FIT for CRC and high-risk polyps. The added value of the second FIT was 12% of total CRCs and 23% of total high-risk polyps.

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Diagnostic Accuracy of a Qualitative Fecal Immunochemical Test Varies With Location of Neoplasia But Not Number of Specimens

Cited by 55 publications

References 29 publications

Strong subsite‐specific variation in detecting advanced adenomas by fecal immunochemical testing for hemoglobin

Strong subsite‐specific variation in detecting advanced adenomas by fecal immunochemical testing for hemoglobin

Colorectal Cancer Screening Based on Age and Gender

Comparison of One versus Two Fecal Immunochemical Tests in the Detection of Colorectal Neoplasia in a Population-Based Colorectal Cancer Screening Program

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