Fecal occult blood versus DNA testing: indirect comparison in a colorectal cancer screening population.
Fecal occult blood versus DNA testing: indirect comparison in a colorectal cancer screening population.
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DOI：
10.2147/clep.s136565
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发表时间：
2017
影响因子：
3.9
通讯作者：
Chen H
中科院分区：
文献类型：
--
作者：
Brenner H;Chen H
在美国和加拿大最近的一项研究中，多靶粪便DNA检测（MSDT）显示出比血红蛋白粪便免疫化学检测（FIT）更高的灵敏度但特异性更低，越来越多地用于结直肠癌（CRC）筛查，尽管其成本比FIT高出约20倍。我们的目的是在一项独立的研究中评估定量FIT在筛查结肠镜检查参与者中的诊断性能，并将其与先前报道的MSDT性能进行比较。共纳入了3494名参与者，年龄在50-84岁之间，他们在德国的私人胃肠病诊所接受了筛查性结肠镜检查，并在结肠镜检查前提供了粪便样本，以通过市售定量FIT（FOB Gold®）进行评价。通过将检测结果与筛查结肠镜检查结果进行比较，评价检测CRC或晚期癌前病变（APCLs）的诊断性能（灵敏度、特异性）。除原始临界值外，我们还使用了调整后的临界值，其特异性与MSDT报告的特异性相同，以增强可比性。结肠镜检查中最晚期的发现分别为30例（0.86%）和359例（10.3%）CRC和APCL。在产生与MSDT报告的相同特异性（86.6%）的截止值时，FIT检测CRC和APCL >1 cm的灵敏度（95%CI）分别为96.7%（82.8-99.9%）和54.3%（48.3-60.3%）。这些灵敏度高于MSDT报告的灵敏度（分别为92.3%和43.6%，p=0.66和0.003）。在这一大型筛选人群中，FIT显示出与MSDT报告的性能相当或更好的诊断性能。
A multitarget stool DNA test (MSDT) that showed higher sensitivity but lower specificity than a fecal immunochemical test (FIT) for hemoglobin in one recent study from the US and Canada, is increasingly used for colorectal cancer (CRC) screening, despite its ~20-fold higher costs compared to FITs. We aimed to assess diagnostic performance of a quantitative FIT in an independent study among participants of screening colonoscopy and to compare it with the previously reported performance of MSDT. A total of 3494 participants, aged 50–84 years, who underwent screening colonoscopy in private gastroenterological practices in Germany, and who provided a stool sample before colonoscopy to be evaluated by a commercially available quantitative FIT (FOB Gold®) were included. Diagnostic performance (sensitivity, specificity) for detecting CRC or advanced precancerous lesions (APCLs) was evaluated by comparison of test results with findings at screening colonoscopy. In addition to the original cutoff, we used an adjusted cutoff yielding the same specificity as reported for the MSDT to enhance comparability. The most advanced finding at colonoscopy was CRC and APCL in 30 (0.86%) and 359 (10.3%) cases, respectively. At a cutoff yielding the same specificity as reported for MSDT (86.6%), the sensitivities (95% CI) of the FIT for detecting CRC and APCL >1 cm were 96.7% (82.8–99.9%) and 54.3% (48.3–60.3%), respectively. These sensitivities are higher than those reported for MSDT (92.3% and 43.6%, p=0.66 and 0.003, respectively). In this large screening population, FIT showed equivalent or better diagnostic performance in comparison to reported performance of MSDT.