Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population
Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population
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DOI：
10.1053/j.gastro.2008.03.040
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发表时间：
2008-07-01
期刊：
影响因子：
29.4
通讯作者：
Dekker, Evelien
中科院分区：
文献类型：
--
作者：
van Rossum, Leo G.;van Rijn, Anne F.;Dekker, Evelien
背景和目的：尽管效果不佳，但基于愈创木脂的粪便潜血测试（G-FOBT）最常用于结直肠。癌症筛查。据称，免疫化学粪便潜血试验（I-FOBT）表现更好，但没有在筛查人群中进行随机比较。我们的目的是在筛查人群中随机比较 G-FOBT 和 I-FOBT。方法：我们对 20,623 名 50-75 岁个体的随机样本进行了一项基于人群的研究，随机分配至 G-FOBT (Hemocult-II) 或 I-FOBT (OC-Sensor)。测试和邀请是一起发送的。对于 I-FOBT，使用 100 ng/ml 的标准截止值。通过结肠镜检查证实 FOBT 呈阳性。晚期腺瘤定义为>= 10 mm、高度不典型增生或>= 20% 绒毛成分。结果：返回了 10,993 份测试。 4836 (46.9%) G-FOBT 和 6157 (59.6%) I-FOBT。参与率差异为 12.7% (P < .01)。在 G-FOBT 中，117 例 (2.4%) 呈阳性，而 I-FOBT 中有 339 例 (5.5%) 呈阳性。阳性率差异为 3.1% (P < .01)。在 G-FOBT 中分别发现了 11 例和 48 例，在 I-FOBT 中分别发现了 24 例和 121 例癌症和晚期腺瘤。癌症、晚期腺瘤和癌症的阳性预测值差异分别为 2.1% (P = .4) 和 -3.6% (P = .5)。特异性差异有利于 G-FOBT，分别为 2.3% (P < .01) 和 -1.3% (P < .01)。意向筛查检出率的差异有利于 I-FOBT，分别为 0.1% (P < .05) 和 0.9% (P < .01)。结论：两次测试之间发现癌症的数量与范围相当。然而，I-FOBT 的晚期腺瘤和癌症的参与率和检出率明显更高。与 I-FOBT 相比，G-FOBT 显着低估了筛查人群中晚期腺瘤和癌症的患病率。
Background & Aims: Despite poor performance, guaiac-based fecal occult blood tests (G-FOBT) are most frequently implemented for colorectal. cancer screening. Immunochemical fecal occult blood tests (I-FOBT) are claimed to perform better, without randomized comparison in screening populations. Our aim was to randomly compare G-FOBT with I-FOBT in a screening population. Methods: We conducted a population-based study on a random sample of 20,623 individuals 50-75 years of age, randomized to either G-FOBT (Hemoccult-II) or I-FOBT (OC-Sensor). Tests and invitations were sent together. For I-FOBT, the standard cutoff of 100 ng/ml was used. Positive FOBTs were verified with colonoscopy. Advanced adenomas were defined as >= 10 mm, high-grade dysplasia, or >= 20% villous component. Results: There were 10,993 tests returned. 4836 (46.9%) G-FOBTs and 6157 (59.6%) I-FOBTs. The participation rate difference was 12.7% (P < .01). Of G-FOBTs, 117 (2.4%) were positive versus 339 (5.5%) of I-FOBTs. The positivity rate difference was 3.1% (P < .01). Cancer and advanced adenomas were found, respectively, in 11 and 48 of G-FOBTs and in 24 and 121 of I-FOBTs. Differences in positive predictive value for cancer and advanced adenomas and cancer were, respectively, 2.1% (P = .4) and -3.6% (P = .5). Differences in specificities favor G-FOBT and were, respectively, 2.3% (P < .01) and -1.3% (P < .01). Differences in intention-to-screen detection rates favor I-FOBT and were, respectively, 0.1% (P < .05) and 0.9% (P < .01). Conclusions: The number-to-scope to find I cancer was comparable between the tests. However, participation and detection rates for advanced adenomas and cancer were significantly higher for I-FOBT. G-FOBT significantly underestimates the prevalence of advanced adenomas and cancer in the screening population compared with I-FOBT.