Fecal Immunochemical Tests Combined With Other Stool Tests for Colorectal Cancer and Advanced Adenoma Detection: A Systematic Review

Abstract

OBJECTIVES:Despite moderate to high detection rates of fecal immunochemical tests (FITs) of colorectal cancer (CRC), detection of adenomas remains limited. Further stool tests exist, which are not used in routine practice, such as DNA or RNA markers and protein markers. We aimed at systematically investigating and summarizing evidence for diagnostic performance of combinations of FIT with other stool tests compared with FIT alone in early detection of CRC and its precursors.METHODS:We systematically reviewed studies that evaluated FITs in combination with other stool tests and compared measures of diagnostic accuracy with and without additional stool tests. PubMed and Web of Science were searched from inception to May 2015. Reference lists of eligible studies were also screened. Two reviewers extracted data independently.RESULTS:Some of the reports on DNA, RNA, or tissue tests, including tests based on DNA mutations, methylation, and integrity in selected genes as well as microRNA expression, showed some improvements of diagnostic test accuracy. In contrast, so far assessed stool protein markers did generally not lead to substantial improvements in performance of FIT when added to the latter. Many marker combinations were reported only in one study each, and few studies were conducted in a true screening setting.CONCLUSIONS:Several stool markers show potential to improve performance of FITs. However, the results require confirmation in further studies, which should also evaluate the costs and cost-effectiveness of combined screening strategies.

Quantitative fecal immunochemical tests for colorectal cancer screening

“…In screening practice, instead of simply applying and strictly sticking to the threshold value recommended by the manufacturer the advantage of quantitative FITs regarding the flexibility for threshold adjustments should be extensively exploited to adjust the threshold value to yield a desired PR (which is a very good proxy indicator for the specificity). Niedermaier et al 50 reviewed the diagnostic performances of FITs in combination with other fecal-based markers until 2015 and came to the conclusion that some combinations might have the potential to improve the diagnostic performance of FITs, but further evaluations in true screening settings are necessary. Such a threshold adjustment has recently been made, for example, in the FIT-based screening program of the Netherlands, where the initial threshold of 15 mg Hb/g feces of FOB Gold was later increased to 47 mg Hb/g feces.…”

“…Robertson et al 16 updated the dataset from Lee et al 17 until 2015 and also extracted sensitivity and specificity values for AA or AN, but did not include any meta-analyses or analyses of determinants of test performance. Niedermaier et al 50 reviewed the diagnostic performances of FITs in combination with other fecal-based markers until 2015 and came to the conclusion that some combinations might have the potential to improve the diagnostic performance of FITs, but further evaluations in true screening settings are necessary. We have summarized the diagnostic performance of quantitative FITs at multiple threshold values for CRC, AA and their combination, AN, exclusively focusing on studies conducted in screening settings with colonoscopy as the reference (gold-)standard among all participants.…”

Fecal immunochemical test for hemoglobin in combination with fecal transferrin in colorectal cancer screening

“…[10][11][12] However, to improve the sensitivity of FITs, especially for the detection of premalignant lesions of CRC, new approaches like the combination of FITs with other stool-based markers are under investigation. 13 Previous studies suggested that combining FITs for hemoglobin with fecal transferrin might increase sensitivity among symptomatic individuals. [14][15][16] For example, Sheng et al reported an increase of sensitivity for CRC and advanced adenoma (AA) from 75% to 90% and from 44% to 78%, respectively.…”

“…However, to improve the sensitivity of FITs, especially for the detection of premalignant lesions of CRC, new approaches like the combination of FITs with other stool‐based markers are under investigation 13 . Previous studies suggested that combining FITs for hemoglobin with fecal transferrin might increase sensitivity among symptomatic individuals 14–16 .…”

Estudio de calidad, seguridad y satisfacción en la colonoscopia de cribado del cáncer colorrectal en el Área de Salud de Salamanca

“…La tasa de detección de adenomas avanzados (TDAa) expresa probablemente un resultado más importante y transcendente que los adenomas en general, debido al número y tamaño de las lesiones y su mayor riesgo de situación avanzada. En el grupo de exposición la TDAa es muy alta (49,1%) comparada con la bibliografía existente (159), y comparada con el grupo control (36%), lo que indica que la intervención es realmente importante para el futuro de estos pacientes por el descenso esperado del riesgo de desarrollar un CCR. Además, la tasa de adenomas avanzados en nuestro estudio se acerca en muchos casos a tasas de adenomas no avanzados de múltiples estudios.…”