Stool DNA and occult blood testing for screen detection of colorectal neoplasia.
Stool DNA and occult blood testing for screen detection of colorectal neoplasia.
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DOI：
10.7326/0003-4819-149-7-200810070-00004
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发表时间：
2008-10-07
影响因子：
39.2
通讯作者：
Hillman SL
中科院分区：
文献类型：
--
作者：
Ahlquist DA;Sargent DJ;Loprinzi CL;Levin TR;Rex DK;Ahnen DJ;Knigge K;Lance MP;Burgart LJ;Hamilton SR;Allison JE;Lawson MJ;Devens ME;Harrington JJ;Hillman SL
粪便DNA检测是检测结直肠癌的一种新方法。从筛选环境中获得的数据很少。比较粪便DNA和粪便血液检测用于检测筛查相关肿瘤（可治愈期癌症、高度异型增生或>1 cm的腺瘤）。设盲、多中心、横断面研究。社区周围的22个参与学术和区域卫生保健系统在美国。4482名平均风险成年人。粪便血液和DNA标记。参与者收集3次粪便，涂抹粪便血液检测卡，并在当天运送到中心机构。对每例患者的3份粪便进行粪便血液卡（Hemoccult和HemoccultSensa，Beckman Coulter，Fullerton，加州）检测，并对1份粪便进行DNA检测。粪便DNA检测1（SDT-1）是一种预商业化的23-标记物检测，一种新的检测（SDT-2）靶向3个广泛的信息标记物。判定标准为结肠镜检查。SDT-1、Hemoccult和HemoccultSensa对筛查相关肿瘤的敏感性分别为20%、11%（P = 0.020）和21%（P = 0.80）;不同检测对癌症和高度异型增生的敏感性无差异。SDT-1的特异性为96%，Hemoccult为98%（P < 0.001），HemoccultSensa为97%（P = 0.20）。粪便DNA检测2检测到46%的筛查相关肿瘤，而Hemoccult检测为16%（P < 0.001），HemoccultSensa检测为24%（P < 0.001）。粪便DNA检测2检测到46%的腺瘤1厘米或更大，相比之下，10%的Hemoccult（P < 0.001）和17%的HemoccultSensa（P < 0.001）。在结肠镜检查正常的患者中，SDT-2的阳性率为16%，Hemoccult为4%（P = 0.010），HemoccultSensa为5%（P = 0.030）。未对所有无筛查相关肿瘤的患者亚组进行粪便DNA检测2。收集粪便时不使用防腐剂，这减少了一些DNA标记物的检测。粪便DNA检测1在检测筛查相关肿瘤方面与HemoccultSensa相比没有改善。粪便DNA检测2比Hemoccult或HemoccultSensa检测出更多的肿瘤，但在结肠镜检查正常的患者中具有更多的阳性结果。SDT-2的高灵敏度对于腺瘤尤其明显。
Stool DNA testing is a new approach to colorectal cancer detection. Few data are available from the screening setting. To compare stool DNA and fecal blood testing for detection of screen-relevant neoplasia (curable-stage cancer, high-grade dysplasia, or adenomas >1 cm). Blinded, multicenter, cross-sectional study. Communities surrounding 22 participating academic and regional health care systems in the United States. 4482 average-risk adults. Fecal blood and DNA markers. Participants collected 3 stools, smeared fecal blood test cards and used same-day shipment to a central facility. Fecal blood cards (Hemoccult and HemoccultSensa, Beckman Coulter, Fullerton, California) were tested on 3 stools and DNA assays on 1 stool per patient. Stool DNA test 1 (SDT-1) was a precommercial 23-marker assay, and a novel test (SDT-2) targeted 3 broadly informative markers. The criterion standard was colonoscopy. Sensitivity for screen-relevant neoplasms was 20% by SDT-1, 11% by Hemoccult (P = 0.020), 21% by HemoccultSensa (P = 0.80); sensitivity for cancer plus high-grade dysplasia did not differ among tests. Specificity was 96% by SDT-1, compared with 98% by Hemoccult (P < 0.001) and 97% by HemoccultSensa (P = 0.20). Stool DNA test 2 detected 46% of screen-relevant neoplasms, compared with 16% by Hemoccult (P < 0.001) and 24% by HemoccultSensa (P < 0.001). Stool DNA test 2 detected 46% of adenomas 1 cm or larger, compared with 10% by Hemoccult (P < 0.001) and 17% by HemoccultSensa (P < 0.001). Among colonoscopically normal patients, the positivity rate was 16% with SDT-2, compared with 4% with Hemoccult (P = 0.010) and 5% with HemoccultSensa (P = 0.030). Stool DNA test 2 was not performed on all subsets of patients without screen-relevant neoplasms. Stools were collected without preservative, which reduced detection of some DNA markers. Stool DNA test 1 provides no improvement over HemoccultSensa for detection of screen-relevant neoplasms. Stool DNA test 2 detects significantly more neoplasms than does Hemoccult or HemoccultSensa, but with more positive results in colonoscopically normal patients. Higher sensitivity of SDT-2 was particularly apparent for adenomas.
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影响因子：
10.3
作者：
Allison, James E.;Sakoda, Lori C.;Selby, Joseph V.
通讯作者：
Selby, Joseph V.
影响因子：
2.5
作者：
Koshiji, M;Yonekura, Y;Yoshioka, K
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Yoshioka, K
影响因子：
29.4
作者：
Ahlquist, DA;Skoletsky, JE;Shuber, AP
通讯作者：
Shuber, AP
影响因子：
10.3
作者：
Chen, WD;Han, ZJ;Markowitz, SD
通讯作者：
Markowitz, SD
影响因子：
9.3
作者：
Kann, Lisa;Han, James;Shuber, Anthony
通讯作者：
Shuber, Anthony