Evaluation of an immunochemical fecal occult blood test with automated reading in screening for colorectal cancer in a general average-risk population
Evaluation of an immunochemical fecal occult blood test with automated reading in screening for colorectal cancer in a general average-risk population
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DOI：
10.1002/ijc.20921
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发表时间：
2005-06-20
影响因子：
6.4
通讯作者：
Caces, ER
中科院分区：
文献类型：
--
作者：
Launoy, GD;Bertrand, HJ;Caces, ER
结直肠癌筛查在所有工业化国家都是高度公共卫生优先事项。然而，普通愈创木筛查试验(HemoccultII)的低敏感性使从业者和公共卫生决策者不愿建立全国性的筛查计划。近年来，基于使用特定抗体的免疫化学测试被发现比血液隐匿性II测试更敏感。然而，为了筛查的目的，只有在特异性和阳性预测值令人满意的情况下，任何敏感性的提高才是有意义的。我们的目的是评估采用自动读取技术(Magstream 1000)的免疫化学测试对不同的血红蛋白含量临界点的性能。这项研究是在科坦丁(法国诺曼底)地区50-74岁的普通人群中进行的。从2001年1月1日至2002年12月31日，全科医生和职业医生在常规会诊结束时对患者进行了7,421次一次性筛查测试(Magstream)。结肠镜检查被建议给434名检测呈阳性的人。2001年1月1日至2003年12月31日期间在研究人群中发生的所有癌症均由全科医生、胃肠病专家和当地登记处收集。以通常的阳性阈值(20 ng Hb/ml)为标准，随访2年后95%顺位的筛查敏感度和特异度分别为0.85(0.72~0.98)和0.94(0.94~0.95)。如果将Hb含量临界点设定为50 ng/ml而不是通常的临界值，则阳性率为3.1%，对癌症或大腺瘤的阳性预测值为0.49，敏感性为0.68-0.83，特异性为0.97。我们的结果表明，使用免疫化学检测和自动读取技术可以改善结直肠癌大规模筛查的前景，因为它提供了一种有望替代愈创木糖检测的方法。(C)2005年Wiley-Liss，Inc.
Colorectal cancer screening is a high public health priority in all industrialized countries. However, the low sensitivity of the common guaiac screening test (HemoccultII) makes practitioners and public health decision makers reluctant to set up a national screening program. In recent years, immunochemical tests based on the use of a specific antibody have been found to be more sensitive than the HemoccultII test. However, for screening purposes, any gain in sensitivity is of interest only if specificity and positive predictive value are satisfactory. Our aim was to assess the performance of an immunochemical test with an automated reading technique (Magstream 1000) for different hemoglobin content cut-off points. The study was carried out in the general population aged 50-74 years in the geographic area of Cotentin (Normandy, France). From I January 2001 to 31 December 2002, 7,421 one-time screening tests (Magstream) were administered by general practitioners and occupational physicians to patients at the end of regular consultations. Colonoscopy was proposed to the 434 people with a positive test. All cancers occurring in the study population between I January 2001 and 31 December 2003 were collected by general practitioners, gastroenterologists and the local registry. At the usual positivity threshold (20 ng hemoglobin/ml), screening sensitivity and specificity at 2 years of follow-up with 95% CIs were, respectively, 0.85 (0.72-0.98) and 0.94 (0.94-0.95). If the hemoglobin content cut-off point had been set at 50 ng/ml instead of the usual cut-off, positivity would have been 3.1% and positive predictive value for a cancer or a large adenoma would have been 0.49, with sensitivity of 0.68-0.83 and specificity of 0.97. Our results suggest that use of an immunochemical test with an automated reading technique could improve the prospects for mass-screening for colorectal cancer since it offers a promising alternative to guaiac tests. (c) 2005 Wiley-Liss, Inc.