Richard F. Logan, MD
Does the fecal immunochemical test (FIT) accurately detect advanced adenoma and advanced neoplasia in persons invited to primary colonoscopy screening?
Blinded comparison of FIT with screening colonoscopy.
Amsterdam and Rotterdam, The Netherlands.
1256 asymptomatic persons (median age 60 y, 51% men) who were scheduled for colonoscopy in a population-based screening trial also completed a FIT before colonoscopy. Exclusion criteria were full colonic examination (complete colonoscopy, computed tomography colonography, and/or double-contrast barium enema) in the past 5 years, planned surveillance colonoscopy (personal history of colorectal cancer, colonic adenomas, or inflammatory bowel disease), or an end-stage disease with life expectancy < 5 years.
1 sample FIT (OC-Sensor, Eiken Chemical, Tokyo, Japan). Patients swept the FIT probe through a stool sample ≤ 48 hours before colonoscopy and before beginning bowel preparation. Samples were stored at −20°C (−4°F) and analyzed within 6 weeks. Cutpoints for hemoglobin (Hb) levels (Hb/mL of test buffer) were 50 ng/mL (10 µg Hb/g feces), 75 ng/mL (15 µg Hb/g feces), and 100 ng/mL (20 µg Hb/g feces).
Sensitivity, specificity, and likelihood ratios for detecting ≥ 1 advanced adenoma (adenoma ≥ 10 mm, ≥ 25% villous, or high-grade dysplasia) and advanced neoplasia (advanced adenoma and/or colorectal carcinoma).
9% of participants had ≥ 1 advanced adenoma, 0.6% had colorectal carcinoma, and 9.5% had advanced neoplasia. Diagnostic test characteristics of FIT are shown in the Table.
In participants who had screening colonoscopy, a single fecal immunochemical test (cutpoint ≥ 50 ng/mL) had 35% sensitivity and 93% specificity for detecting advanced adenoma, and 38% sensitivity and 93% specificity for detecting advanced neoplasia.
Diagnostic test characteristics of fecal immunochemical test (FIT) in persons invited to primary screening colonoscopy for colorectal cancer*
*NNS = number needed to screen; diagnostic terms defined in Glossary.
Logan RF. A single FIT (≥ 50 ng Hb/mL) detected 38% of screen-detected advanced colorectal neoplasia. Ann Intern Med. ;157:JC5–10. doi: 10.7326/0003-4819-157-10-201211200-02010
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Published: Ann Intern Med. 2012;157(10):JC5-10.
Cancer Screening/Prevention, Colonoscopy/Sigmoidoscopy, Colorectal Cancer, Gastroenterology/Hepatology, Gastrointestinal Cancer.
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