Improved screening for colorectal cancer by immunological detection of occult blood

Frommer, D.; Kapparis, A; BROWN, M.

doi:10.1136/bmj.296.6629.1092

Cited by 41 publications

(7 citation statements)

References 16 publications

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“…Patterns of bleeding may significantly affect the sensitivity of FOB tests and may explain why we observed higher sensitivities for Dukes' stages C and D than for stages A and B. Similar observations were made by Frommer et al who found improved sensitivity for Dukes' A tumours compared with Dukes' D when using non-rehydrated Hamoccult II 28. St John et al demonstrated sensitivities of 63.6% for stage A and B tumours compared with 89.7% for stages C and D when using the HaemoQuant FOB 37.…”

Section: Discussionsupporting

confidence: 90%

Faecal calprotectin and faecal occult blood tests in the diagnosis of colorectal carcinoma and adenoma

Tibble

2001

Gut

153

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Background and aims-Testing for faecal occult blood has become an accepted technique of non-invasive screening for colorectal neoplasia but lack of sensitivity remains a problem. The aim of this study was to compare the sensitivity and specificity of faecal calprotectin and faecal occult blood in patients with colorectal cancer and colonic polyps. Methods-Faecal calprotectin and occult blood were assessed in 62 patients with colorectal carcinoma and 233 patients referred for colonoscopy. The range of normality for faecal calprotectin (0.5-10.5 mg/l) was determined from 96 healthy subjects. Results-Median faecal calprotectin concentration in the 62 patients with colorectal carcinoma (101 mg/l, 95% confidence interval (CI) 57-133) diVered significantly from normal (2.3 mg/l, 95% CI 1.6-5.0) with 90% of patients having elevated levels (normal <10 mg/l) whereas only 36/62 (58%) had positive faecal occult bloods. There was no significant diVerence in faecal calprotectin levels when considering location or Dukes' staging of tumour. Percentage positivity of faecal occult bloods was significantly higher for Dukes' stage C and D cancers compared with Dukes' A and B. In the colonoscopy group, 29 patients with adenomatous polyps were detected in whom the median faecal calprotectin was 12 mg/l (95% CI 2.9-32). Sensitivity for detection of adenomatous polyps was 55% using the calprotectin method and 10% using faecal occult blood testing. The overall sensitivity and specificity of calprotectin for colorectal cancer and adenomatous polyps as a combined group was 79% and 72%, respectively, compared with a sensitivity and specificity of faecal occult blood of 43% and 92%. Conclusions-Faecal calprotectin is a simple and sensitive non-invasive marker of colorectal cancer and adenomatous polyps. It is more sensitive than faecal occult blood tests for detection of colorectal neoplasia at the cost of a somewhat lower specificity. (Gut 2001;49:402-408)

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Section: Discussionsupporting

confidence: 90%

Faecal calprotectin and faecal occult blood tests in the diagnosis of colorectal carcinoma and adenoma

Tibble

2001

Gut

153

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“…Endoscopy gives the most direct impression of gastric damage (Caruso & Bianchi Porro, 1980) but can only be performed acutely or at most infrequently during long term treatment, whereas no information is obtained about possible damage to parts of the small intestine that cannot be visualised (Bjarnason et al, 1984). Immunological detection of intact haemoglobin in the faeces (Frommer et al, 1988) is of limited use for the detection of effects of NSAIDs since the haemoglobin from the upper gastrointestinal tract reaches the faeces mainly as porphyrins, which are not recognised by the antibody.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal blood loss after non‐steroidal anti‐inflammatory drugs. Measurement by selective determination of faecal porphyrins.

Cohen

Boeijinga

Haard

et al. 1992

Brit J Clinical Pharma

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1. A method for the detection of gastrointestinal blood loss based upon the selective measurement of faecal porphyrins was tested in two studies in healthy volunteers. 2. In the first study subjects (n = 6) received intragastric autologous blood (saline, 2 and 6 ml as a single dose) resulting in a dose dependent increase in faecal porphyrins. 3. In a subsequent placebo controlled cross over study in 12 subjects acetylsalicylic acid (ASA), nabumetone (a new NSAID) or placebo were administered for 5 days with a washout period of 9 days. They were no dietary restrictions. 4. All faeces were collected during the treatment period and both the full faecal homogenate and a random faecal sample were analyzed for deutero‐ and pemptoporphyrin content by h.p.l.c. Additionally a benzidine reaction was performed. 5. There was a highly significant correlation (r = 0.95) between the values obtained from random samples and the full homogenate. ASA increased the faecal porphyrin excretion (P less than 0.001) compared with placebo in contrast to nabumetone. Complaints of dyspepsia were most common after ASA. 6. Measurement of faecal porphyrins is useful for monitoring NSAID induced upper gastrointestinal blood loss and lacks some of the practical constraints of other methods.

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“…As gFOBT is non‐specific to human haemoglobin, dietary restriction is needed before stool sample collection; whereas, iFOBT has minimal restrictions . The diagnostic performance of iFOBT has been shown better than that of gFOBT; however, some reported FOBT detection rates might not be verified by colonoscopic result . These studies have been included in meta‐analyses to evaluate the diagnostic performance of FOBT; verification bias might be induced and potentially leaded to an overestimation of sensitivity of FOBT by about 34% …”

Section: Introductionmentioning

confidence: 99%

Systematic review with meta‐analysis: faecal occult blood tests show lower colorectal cancer detection rates in the proximal colon in colonoscopy‐verified diagnostic studies

Hirai

Tsoi

Chan

et al. 2016

Aliment Pharmacol Ther

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Improved screening for colorectal cancer by immunological detection of occult blood

Abstract: Immunological detection of occult blood in faecal samples seems to show more adenomas and carcinomas (particularly early lesions) than the Hemoccult II kit and has a rate of false positive results that is acceptably low.

Cited by 41 publications

References 16 publications

Faecal calprotectin and faecal occult blood tests in the diagnosis of colorectal carcinoma and adenoma

Faecal calprotectin and faecal occult blood tests in the diagnosis of colorectal carcinoma and adenoma

Gastrointestinal blood loss after non‐steroidal anti‐inflammatory drugs. Measurement by selective determination of faecal porphyrins.

Systematic review with meta‐analysis: faecal occult blood tests show lower colorectal cancer detection rates in the proximal colon in colonoscopy‐verified diagnostic studies

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