Screening for colorectal neoplasms with new fecal occult blood tests: update on performance characteristics
Screening for colorectal neoplasms with new fecal occult blood tests: update on performance characteristics
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DOI：
10.1093/jnci/djm150
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发表时间：
2007-10-03
影响因子：
10.3
通讯作者：
Selby, Joseph V.
中科院分区：
文献类型：
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作者：
Allison, James E.;Sakoda, Lori C.;Selby, Joseph V.
背景 一种粪便潜血试验 (FOBT)，即未再水合愈创木脂粪便潜血试验 (GT)，被美国预防服务工作组和医学研究所推荐用于筛查计划，但作为检测晚期结肠肿瘤（癌症和直径 >= 1 厘米的腺瘤性息肉）的单一测试，其敏感性相对较低。因此，提高 FOBT 的敏感性应该会使使用这些测试的结肠癌筛查计划更加有效。 方法 我们前瞻性地评估了大型团体模式管理医疗组织中 5841 名具有结直肠癌平均风险的受试者中两种较新 FOBT 的表现特征。评估的测试包括敏感 GT、粪便免疫化学测试 (FIT) 以及这两种测试的组合。建议检测结果呈阳性和阴性的患者分别进行结肠镜检查和乙状结肠镜检查。对单独和联合进行的两项测试评估了 FOBT 筛查后 2 年内检测左结肠晚期肿瘤的敏感性和特异性。 结果 在初次 FOBT 筛查后 2 年内，共有 139 名患者被诊断患有晚期结直肠肿瘤（n = 14 例癌症，In = 128 例腺瘤）。单独使用 FIT 检测癌症的敏感性为 81.8%（95% 置信区间 [CI] = 47.8% 至 96.8%），敏感性 GT 和组合检测的敏感性为 64.3%（95% CI = 35.6% 至 86.0%）。敏感 GT 检测晚期结直肠腺瘤的敏感性为 41.3%（95% Cl = 32.7% 至 50.4%），FIT 为 29.5%（95% Cl = 21.4% 至 38.9%），组合测试为 22.8%（95% Cl = 16.1% 至 31.3%）。联合检测检测癌症和腺瘤的特异性分别为 98.1%（95% Cl = 97.7% 至 98.4%）和 98.4%（95% Cl = 98.0% 至 98.7%）； FIT 分别为 96.9%（95% C1 = 96.4% 至 97.4%）和 97.3%（95% CI = 96.8% 至 97.7%）；敏感 GT 的准确率分别为 90.1%（95% Cl = 89.3% 至 90.8%）和 90.6%（95% Cl = 89.8% 至 91.4%）。结论 FIT 对检测左侧结直肠癌具有较高的灵敏度和特异性，可能是 GT 的有用替代品。
Background One type of fecal occult blood test (FOBT), the unrehydrated guaiac fecal occult blood test (GT), is recommended by the United States Preventive Services Task Force and the Institute of Medicine for use in screening programs, but it has relatively low sensitivity as a single test for detecting advanced colonic neoplasms (cancer and adenomatous polyps >= 1 cm in diameter). Thus, improving the sensitivity of FOBT should make colon cancer screening programs that use these tests more effective.Methods We assessed prospectively the performance characteristics of two newer FOBTs in 5841 subjects at average risk for colorectal cancer in a large group-model managed care organization. The tests evaluated included a sensitive GT, a fecal immunochemical test (FIT), and the combination of both tests. Patients with positive and negative test results were advised to have colonoscopy and sigmoidoscopy, respectively. Sensitivity and specificity for detecting advanced neoplasms in the left colon within 2 years after the FOBT screening were evaluated for the two tests administered separately and in combination.Results A total of 139 patients were diagnosed with advanced colorectal neoplasms (n = 14 cancers, In = 128 adenomas) within the 2 years following their initial FOBT screening. Sensitivity for detecting cancer was 81.8% (95% confidence interval [CI] = 47.8% to 96.8%) for the FIT alone and 64.3% (95% Cl = 35.6% to 86.0%) for the sensitive GT and the combination test. Sensitivity for detecting advanced colorectal adenomas was 41.3% (95% Cl = 32.7% to 50.4%) for the sensitive GT, 29.5% (95% Cl = 21.4% to 38.9%) for the FIT, and 22.8% (95% Cl =16.1% to 31.3%) for the combination test. Specificity for detecting cancer and adenomas was 98.1% (95% Cl = 97.7% to 98.4%) and 98.4% (95% Cl = 98.0% to 98.7%), respectively, for the combination test; 96.9% (95% C1 = 96.4% to 97.4%) and 97.3% (95% CI = 96.8% to 97.7%), respectively, for the FIT; and 90.1% (95% Cl = 89.3% to 90.8%) and 90.6% (95% Cl = 89.8% to 91.4%), respectively, for the sensitive GT.Conclusions The FIT has high sensitivity and specificity for detecting left-sided colorectal cancer, and it may be a useful replacement for the GT.