Faecal immunochemical test accuracy in patients referred for surveillance colonoscopy: a multi-centre cohort study

BMC Gastroenterology

Chris JJ Mulder⁸  Veerle MH Coupé⁶  Ruud JLF Loffeld⁵  Pieter Scholten⁴  Annekatrien CTM Depla⁷  Gerrit A Meijer²  Anneke A Bouman³  Ruud Duijkers⁸  Lisette van der Eem⁸  Usha Coblijn⁸  Vincent A Steeman⁸  René WM van der Hulst¹  Frank A Oort⁸  Sietze T van Turenhout⁸  Jochim S Terhaar sive Droste⁹ 

[1] Gastroenterology and Hepatology, Kennemer Gasthuis, Haarlem, The Netherlands;Pathology, VU University Medical Centre, Amsterdam, The Netherlands;Clinical Chemistry, VU University Medical Centre, Amsterdam, The Netherlands;Gastroenterology and Hepatology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands;Internal Medicine, Zaans Medical Centre, Zaandam, The Netherlands;Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands;Gastroenterology and Hepatology, Slotervaart Hospital, Amsterdam, The Netherlands;Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands;Department of Gastroenterology and Hepatology, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands

关键词: Sensitivity;    Advanced adenoma;    Surveillance;    Faecal immunochemical test (FIT);    Colorectal cancer;   

Others  :  1121911
DOI  :  10.1186/1471-230X-12-94

 received in 2012-01-10, accepted in 2012-07-24,  发布年份 2012

【 摘 要 】

Background

Given the increasing burden on colonoscopy capacity, it has been suggested that faecal immunochemical test (FIT) results could guide surveillance colonoscopy intervals. Against this background, we have evaluated the test accuracy of single and double FIT sampling to detect colorectal cancer (CRC) and/or advanced adenomas in an asymptomatic colonoscopy-controlled high-risk population.

Methods

Cohort study of asymptomatic high-risk patients (personal history of adenomas/CRC or family history of CRC), who provided one or two FITs before elective colonoscopy. Test accuracy of FIT for detection of CRC and advanced adenomas was determined (cut-off level 50 ng/ml).

Results

1,041 patients provided a FIT (516 personal history of adenomas, 172 personal history of CRC and 353 family history of CRC). Five CRCs (0.5%) and 101 advanced adenomas (9.7%) were detected by colonoscopy. Single FIT sampling resulted in a sensitivity, specificity, PPV and NPV for CRC of 80%, 89%, 3% and 99.9%, respectively, and for advanced adenoma of 28%, 91%, 24% and 92%, respectively. Double FIT sampling did not result in a significantly higher sensitivity for advanced neoplasia. Simulation of multiple screening rounds indicated that sensitivity of FIT for advanced adenoma could reach 81% after 5 screening rounds.

Conclusions

In once-only FIT sampling before surveillance colonoscopy, 70% of advanced neoplasia were missed. A simulation approach indicates that multiple screening rounds may be more promising in detecting advanced neoplasia and could potentially alleviate endoscopic burden.

【 授权许可】

   
2012 Terhaar sive Droste et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Seeff LC, Manninen DL, Dong FB, et al.: Is there endoscopic capacity to provide colorectal cancer screening to the unscreened population in the United States? Gastroenterology 2004, 127:1661-1669.
• [2]Nnoaham KE, Lines C: Modelling future capacity needs and spending on colonoscopy in the English bowel cancer screening programme. Gut 2008, 57:1238-1245.
• [3]Terhaar sive Droste JS, Craanen ME, Kolkman JJ, et al.: Dutch endoscopic capacity in the era of colorectal cancer screening. Neth J Med 2006, 64:371-373.
• [4]Lieberman DA, Holub J, Eisen G, et al.: Utilization of colonoscopy in the United States: results from a national consortium. Gastrointest Endosc 2005, 62:875-883.
• [5]Terhaar sive Droste JS, Craanen ME, van der Hulst RWM, et al.: Colonoscopic yield of colorectal neoplasia in daily clinical practice. World J Gastroenterol 2009, 15:1085-1092.
• [6]Health Council of the Netherlands: Population-based screening for colorectal cancer. Health Council of the Netherlands, The Hague; 2009. publication number 2009/13. Ref Type: Dutch Report
• [7]Hazazi R, Rozen P, Leshno M, et al.: Can patients at high risk for significant colorectal neoplasms and having normal quantitative faecal occult blood test postpone elective colonoscopy? Aliment Pharmacol Ther 2010, 31:523-533.
• [8]Gimeno-García AZ, Quintero E, Nicolás-Pérez D, et al.: Screening for familial colorectal cancer with a sensitive immunochemical fecal occult blood test: a pilot study. Eur J Gastroenterol Hepatol 2009, 21:1062-1067.
• [9]Duffy MJ, van Rossum LG, van Turenhout ST, et al.: Use of faecal markers in screening for colorectal neoplasia: a European group on tumor markers position paper. Int J Cancer 2011, 128:3-11.
• [10]Winawer SJ, Zauber AG, Fletcher RH, et al.: Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology 2006, 130:1872-1885.
• [11]Rex DK, Johnson DA, Anderson JC, et al.: American College of Gastroenterology guidelines for colorectal cancer screening 2008. Am J Gastroenterol 2009, 104:739-750.
• [12]Caffarey SM, Broughton CI, Marks CG: Faecal occult blood screening for colorectal neoplasia in a targeted high-risk population. Br J Surg 1993, 80:1399-1400.
• [13]Guittet L, Bouvier V, Mariotte N, et al.: Comparison of a guaiac based and an immunochemical faecal occult blood test in screening for colorectal cancer in a general average risk population. Gut 2007, 56:210-214.
• [14]van Rossum LG, van Rijn AF, Laheij RJ, et al.: Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population. Gastroenterology 2008, 135:82-90.
• [15]Levi Z, Birkenfeld S, Vilkin A, et al.: A higher detection rate for colorectal cancer and advanced adenomatous polyp for screening with immunochemical fecal occult blood test than guaiac fecal occult blood test, despite lower compliance rate. A prospective, controlled, feasibility study. Int J Cancer 2011, 128:2415-2424.
• [16]Oort FA, Terhaar sive Droste JS, van der Hulst RWM, et al.: FIT is superior to g-FOBT in detecting screen relevant neoplastic lesions: a colonoscopy controlled intra-individual comparison. Aliment Pharmacol Ther 2010, 31:432-439.
• [17]Dancourt V, Lejeune C, Lepage C, et al.: Immunochemical faecal occult blood tests are superior to guaiac-based tests for the detection of colorectal neoplasms. Eur J Cancer 2008, 44:2254-2258.
• [18]Hol L, Wilschut JA, van Ballegooijen M, et al.: Screening for colorectal cancer: random comparison of guaiac and immunochemical faecal occult blood testing at different cut-off levels. Br J Cancer 2009, 100:1103-1110.
• [19]Allison JE, Tekawa IS, Ransom LJ, et al.: A comparison of fecal occult-blood tests for colorectal-cancer screening. N Engl J Med 1996, 334:155-159.
• [20]Levi Z, Hazazi R, Rozen P, et al.: A quantitative immunochemical faecal occult blood test is more efficient for detecting significant colorectal neoplasia than a sensitive guaiac test. Aliment Pharmacol Ther 2006, 23:1359-1364.
• [21]Oort FA, van Turenhout ST, Coupe VM, van der Hulst RW, Wesdorp EI, Terhaar Sive Droste JS, Ben LI, Kanis SL, van Hengel E, Bouman AA, Meijer GA, Mulder CJ: Double sampling of a faecal immunochemical test is not superior to single sampling for detection of colorectal neoplasia: a colonoscopy controlled prospective cohort study. BMC Cancer 2011, 11:434. BioMed Central Full Text
• [22]Rozen P, Levin B, Young GP: Who is at risk from familial colorectal cancer and how can they be managed? Colorectal cancer in clinical practice 2nd edition. 2005, 67-84.
• [23]Pignone M, Campbell MK, Carr C, et al.: Meta-analysis of dietary restriction during fecal occult blood testing. Eff Clin Pract 2001, 4:150-156.
• [24]Rozen P, Waked A, Vilkin A, et al.: Evaluation of a desk top instrument for the automated development and immunochemical quantification of fecal occult blood. Med Sci Monit 2006, 12:MT27-MT32.
• [25]Rex DK, Kahi CJ, Levin B, American Cancer Society; US Multi-Society Task Force on Colorectal Cancer, et al.: Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2006, 130:1865-1871.
• [26]Winawer SJ, Zauber AG, O'Brien MJ, et al.: Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. N Engl J Med 1993, 328:901-906.
• [27]Cairns SR, Scholefield JH, Steele RJ, British Society of Gastroenterology; Association of Coloproctology for Great Britain and Ireland, et al.: Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010, 59(5):666-689. Review
• [28]Dutch Institute for Healthcare Improvement CBO: Follow-up after polypectomy. Van Zuiden Communications B.V., Utrecht; 2002. Ref Type: Report
• [29]Lane JM, Chow E, Young GP, et al.: Interval fecal immunochemical testing in a colonoscopic surveillance program speeds detection of colorectal neoplasia. Gastroenterology 2010, 139:1918-1926.
• [30]Cripps NPJ, Heald RJ: Family based colorectal cancer screening in a district hospital. Gut 1996, 38:421-425.
• [31]Hunt LM, Rooney PS, Bostock K, et al.: Chemical and immunological testing for fecal occult blood in screening subjects at risk of familial colorectal cancer. Gut 1997, 40:110-112.
• [32]Skaife P, Seow-Choen F, Eu KW, et al.: A novel indicator for surveillance colonoscopy following colorectal cancer resection. Colorectal Dis 2003, 5:45-48.
• [33]Robinson MH, Kronborg O, Williams CB, et al.: Faecal occult blood testing and colonoscopy in the surveillance of subjects at high risk of colorectal neoplasia. Br J Surg 1995, 82:318-320.
• [34]Hundt S, Haug U, Brenner H: Comparative evaluation of immunochemical fecal occult blood tests for colorectal adenoma detection. Ann Intern Med 2009, 150:162-169.
• [35]Segnan N, Patnick J, von Karsa L: European guidelines for quality assurance in colorectal cancer screening and diagnosis. 1st edition. 2010, E818-E830.
• [36]Kronborg O, Jørgensen OD, Fenger C, et al.: Three randomized long-term surveillance trials in patients with sporadic colorectal adenomas. Scand J Gastroenterol 2006, 41:737-743.