Comparison of a guaiac based and an immunochemical faecal occult blood test in screening for colorectal cancer in a general average risk population
Comparison of a guaiac based and an immunochemical faecal occult blood test in screening for colorectal cancer in a general average risk population
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DOI：
10.1136/gut.2006.101428
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发表时间：
2007-02-01
期刊：
影响因子：
24.5
通讯作者：
Launoy, G.
中科院分区：
文献类型：
--
作者：
Guittet, L.;Bouvier, V.;Launoy, G.
背景资料：愈创木脂粪便潜血试验（G-FOBT）被推荐作为结直肠癌的筛查试验，但其敏感性低，阻碍了其在全世界的应用。方法：我们比较了参考G-FOBT的性能（非再水化隐血II试验）和免疫化学粪便隐血试验（I-FOBT），使用不同的阳性临界值，在完成这两项测试的10673名患者的平均风险人群样本中，至少有一个测试阳性的患者被要求接受colonoscopy.Results：使用通常的截止点20 ng/ml血红蛋白，增益与使用I-FOBT（50%增加癌症和256%增加高风险腺瘤）的敏感性是平衡的特异性下降。与检测到一个额外的晚期肿瘤（癌症或高危腺瘤）相关的额外假阳性结果的数量为2.17（95%置信区间1.65-2.85）。阈值为50 ng/ml时，I-FOBT检测到的晚期肿瘤是G-FOBT的两倍多（灵敏度比= 2.33），而特异性没有任何损失（假阳性率比= 0.99）。与阈值为75 ng/ml，与类似的阳性率G-FOBT（2.4%），使用I-FOBT允许增益的敏感性为90%，并在33%的假阳性率降低为先进neoplasia.Conclusions：证据表明，有利于取代G-FOBT的I-FOBT正在增加，增益是更重要的高风险腺瘤比癌症。自动阅读技术允许选择与灵敏度和特异性之间的理想平衡相关的阳性率。
Background: The guaiac faecal occult blood test (G-FOBT) is recommended as a screening test for colorectal cancer but its low sensitivity has prevented its use throughout the world.Methods: We compared the performances of the reference G-FOBT (non-rehydrated Hemoccult II test) and the immunochemical faecal occult blood test (I-FOBT) using different positivity cut-off values in an average risk population sample of 10 673 patients who completed the two tests. Patients with at least one test positive were asked to undergo colonoscopy.Results: Using the usual cut-off point of 20 ng/ml haemoglobin, the gain in sensitivity associated with the use of I-FOBT (50% increase for cancer and 256% increase for high risk adenoma) was balanced by a decrease in specificity. The number of extra false positive results associated with the detection of one extra advanced neoplasia (cancer or high risk adenoma) was 2.17 (95% confidence interval 1.65-2.85). With a threshold of 50 ng/ml, I-FOBT detected more than twice as many advanced neoplasias as the G-FOBT (ratio of sensitivity = 2.33) without any loss in specificity (ratio of false positive rate = 0.99). With a threshold of 75 ng/ml, associated with a similar positivity rate to G-FOBT (2.4%), the use of I-FOBT allowed a gain in sensitivity of 90% and a decrease in the false positive rate of 33% for advanced neoplasia.Conclusions: Evidence in favour of the substitution of G-FOBT by I-FOBT is increasing, the gain being more important for high risk adenomas than for cancers. The automated reading technology allows choice of the positivity rate associated with an ideal balance between sensitivity and specificity.