Sensitivity, but Not Specificity, of a Quantitative Immunochemical Fecal Occult Blood Test for Neoplasia Is Slightly Increased by the Use of Low-Dose Aspirin, NSAIDS, and Anticoagulants

Levi, Zohar; Rozen, Paul; Hazazi, Rachel; Vilkin, Alex; Waked, Amal; Maoz, Eran; Birkenfeld, Shlomo; Lieberman, Nicky; Klang, Shmuel; Niv, Yaron

doi:10.1038/ajg.2009.14

Cited by 63 publications

(65 citation statements)

References 10 publications

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“…29,30,35 However, in our study, although a low proportion of participants used antiplatelet drugs, their false-positive test rate did increase, such that the sensitivity was increased (32.3% v. 24.3% for the whole study population), but the specificity was reduced (72.9% v. 89.0%) (see Appendix 1). …”

Section: Discussionmentioning

confidence: 64%

Performance of the immunochemical fecal occult blood test in predicting lesions in the lower gastrointestinal tract

Chiang¹,

Lee²,

Tu³

et al. 2011

Canadian Medical Association Journal

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Section: Discussionmentioning

confidence: 64%

Performance of the immunochemical fecal occult blood test in predicting lesions in the lower gastrointestinal tract

Chiang¹,

Lee²,

Tu³

et al. 2011

Canadian Medical Association Journal

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“…Higher rates of minute gastrointestinal mucosal bleeding are expected in individuals with CKD because of anti-coagulation use during dialysis, potential uraemic induced platelet defects and the use immunosuppressive agents leading to possible adverse effects on test specificity. Furthermore, previous studies have also shown that the test sensitivity rate increases with the use of low-dose aspirin by increasing the likelihood of bleeding from colorectal neoplasms in the general population (23,24). It is unclear whether lowdose aspirin, or other anti-platelet agents, which are used frequently in the CKD population for the primary and secondary prevention of cardiovascular disease, will have the similar effects on the iFOBT test performance characteristics.…”

Section: Screening For Colorectal Cancer In the Ckd Populationmentioning

confidence: 99%

Test performance of faecal occult blood testing for the detection of bowel cancer in people with chronic kidney disease (DETECT) protocol

et al. 2011

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Background: Cancer is a major cause of mortality and morbidity in patients with chronic kidney disease (CKD). In patients without kidney disease, screening is a major strategy for reducing the risk of cancer and improving the health outcomes for those who developed cancers by detecting treatable cancers at an early stage. Among those with CKD, the effectiveness, the efficacy and patients' preferences for cancer screening are unknown. Methods/Design: This work describes the protocol for the DETECT study examining the effectiveness, efficiency and patient's perspectives of colorectal cancer screening using immunochemical faecal occult blood testing (iFOBT) for people with CKD. The aims of the DETECT study are 1) to determine the test performance characteristics of iFOBT screening in individuals with CKD, 2) to estimate the incremental costs and health benefits of iFOBT screening in CKD compared to no screening and 3) to elicit patients' perspective for colorectal cancer screening in the CKD population. Three different study designs will be used to explore the uncertainties surrounding colorectal cancer screening in CKD. A diagnostic test accuracy study of iFOBT screening will be conducted across all stages of CKD in patients ages 35-70. Using individually collected direct healthcare costs and outcomes from the diagnostic test accuracy study, cost-utility and cost-effective analyses will be performed to estimate the costs and health benefits of iFOBT screening in CKD. Qualitative in-depth interviews will be undertaken in a subset of participants from the diagnostic test accuracy study to investigate the perspectives, experiences, attitudes and beliefs about colorectal cancer screening among individuals with CKD. Discussion: The DETECT study will target the three major unknowns about early cancer detection in CKD. Findings from our study will provide accurate and definitive estimates of screening efficacy and efficiency for colorectal cancer, and will allow better service planning and budgeting for early cancer detection in this at-risk population. The DETECT study is also registered with the Australia New Zealand Clinical Trials Registry ACTRN12611000538943

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“…Additionally, medications that can increase the likelihood of GI bleeding may cause false-positive FIT results. However, recent data, although not sufficient, demonstrated that low-dose aspirin, nonsteroidal antiinflammatory drugs (NSAIDS), and anticoagulant use have no or marginal effects on the specificity of FIT, rather they increase the sensitivity of FIT [16,17]. At this time, concomitant use of those drugs does not seem to be the culprit behind FIT false-positive results.…”

mentioning

confidence: 94%

Small Bowel Evaluation in Asymptomatic Fecal Immunochemical Test-Positive Patients with a Negative Colonoscopy: Is It Necessary?

Park

Cheon

2011

Dig Dis Sci

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Screening for colorectal cancer (CRC) and its precursors by fecal occult blood test (FOBT) is widely recommended and is being applied more than ever [1][2][3]. Although annual or biennial guaiac fecal occult blood test (gFOBT) screening has been proved to reduce the mortality of CRC [4], the gFOBT has been faulted for its low sensitivity [5,6]. More recently, the fecal immunochemical test (FIT) has been introduced as an alternative to the gFOBT. The FIT is currently preferred over the gFOBT due to its higher sensitivity and improved detection rate for advanced neoplasia [5,[7][8][9][10]. Besides its diagnostic performance, the FIT has several advantages over the gFOBT including no need for dietary restriction, easier stool collection method, and automated analysis [11]. Furthermore, quantitative FIT allows for the adjustment of the cutoff value for an abnormal result based on population characteristics and available colonoscopy resources. Due to these characteristics, quantitative FIT is more favored as a screening tool than qualitative FIT [11].The FIT selectively reacts with the globin moiety of human hemoglobin [12]. Because globin is rapidly degraded by proteases in the upper gastrointestinal (GI) tract, the FIT dose not detect small amounts of blood in the upper GI tract and selectively recognizes occult bleeding of colorectal origin [12]. With regard to small bowel lesions, although there is a possibility that some small bowel occult bleeding could be identified by FIT, no data are currently available regarding this issue.In the current issue of Digestive Diseases and Sciences, Chiba et al.[13] present the results of their prospective study on small bowel evaluation in asymptomatic FIT-positive subjects with a negative colonoscopy. In this, the first study to evaluate the small bowel with capsule endoscopy (CE) in asymptomatic FIT-positive patients with a negative colonoscopy, 53 asymptomatic patients with FIT-positivity and a negative total colonoscopy and esophagogastroduodenoscopy underwent CE. The CE findings were classified into three categories: P0, no abnormalities or findings without potential for bleeding; P1, findings with uncertain potential for bleeding; and P2, findings with high potential for bleeding. The cecal completion rate was 92.5%. There were no cases of P2, 19 cases of P1, and 34 cases of P0. Moreover, no abnormalities were identified in five patients who underwent additional diagnostic evaluations that were considered necessary based on the individual clinical results. No clinically significant small bowel lesions were found in the asymptomatic FIT-positive patients with negative bidirectional endoscopy.Although FIT has been widely accepted as a CRC screening tool, 40-60% of subjects with a positive FIT are found to have no lesions in their colon or rectum to explain their positive status [5,14,15]. How then do we explain the discrepancy between the results of FIT and colonoscopy? There are several possible explanations for this discrepancy. First, this may reflect true false-positiv...

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Sensitivity, but Not Specificity, of a Quantitative Immunochemical Fecal Occult Blood Test for Neoplasia Is Slightly Increased by the Use of Low-Dose Aspirin, NSAIDS, and Anticoagulants

Abstract: The use of aspirin/NSAIDS and anticoagulants was associated with a trend for increased sensitivity with no change in specificity for the detection of AAP/CRC. This study suggests that there is no need to stop these agents before I-FOBT testing.

Cited by 63 publications

References 10 publications

Performance of the immunochemical fecal occult blood test in predicting lesions in the lower gastrointestinal tract

Performance of the immunochemical fecal occult blood test in predicting lesions in the lower gastrointestinal tract

Test performance of faecal occult blood testing for the detection of bowel cancer in people with chronic kidney disease (DETECT) protocol

Small Bowel Evaluation in Asymptomatic Fecal Immunochemical Test-Positive Patients with a Negative Colonoscopy: Is It Necessary?

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