Advances in Fecal Occult Blood Tests: the FIT revolution.
Advances in Fecal Occult Blood Tests: the FIT revolution.
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DOI：
10.1007/s10620-014-3445-3
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发表时间：
2015-03
影响因子：
3.1
通讯作者：
Seaman, Helen E.
中科院分区：
文献类型：
--
作者：
Young, Graeme P.;Symonds, Erin L.;Allison, James E.;Cole, Stephen R.;Fraser, Callum G.;Halloran, Stephen P.;Kuipers, Ernst J.;Seaman, Helen E.
粪便潜血试验（FOBTs）用于结直肠癌筛查的选择范围很广。目标：强调选择FOBT时适用的问题，特别是哪种FOBT最适合筛查场景。四种情况描述了筛查计划的限制和期望：（1）有限的结肠镜资源，需要限制测试阳性率;（2）优先考虑最大限度地检测结直肠肿瘤，几乎不需要限制结肠镜工作量;（3）“足够的”内窥镜资源，允许平衡检测的好处与服务提供的负担;以及（4）需要最大限度地参与筛选。基于愈创木脂的FOBT（gFOBT）有明显的缺陷，血红蛋白的粪便免疫化学测试（FIT）已经成为更好的测试。gFOBT对少量出血不敏感，特异性可能受饮食或药物影响，受试者接受度可能较低，实验室质量控制机会有限，并且它们具有确定阳性的固定血红蛋白浓度截止值。FIT在分析上更具特异性，能够定量，因此可以灵活调整阳性的截止浓度以及灵敏度和特异性之间的平衡。FIT在临床上对癌症和晚期腺瘤更敏感，并且因为它们更容易使用，接受率很高。结论：FOBT必须仔细选择，以满足适用的筛选方案的需要。定量FIT可以进行调整，以适应情景1，2和3，对于每一个，它们都是选择的测试。对于场景4，FIT上级于gFOBT，而gFOBT仅适用于场景1。
There is a wide choice of fecal occult blood tests (FOBTs) for colorectal cancer screening. Goal: To highlight the issues applicable when choosing a FOBT, in particular which FOBT is best suited to the range of screening scenarios. Four scenarios characterize the constraints and expectations of screening programs: (1) limited colonoscopy resource with a need to constrain test positivity rate; (2) a priority for maximum colorectal neoplasia detection with little need to constrain colonoscopy workload; (3) an “adequate” endoscopy resource that allows balancing the benefits of detection with the burden of service provision; and (4) a need to maximize participation in screening. Guaiac-based FOBTs (gFOBTs) have significant deficiencies, and fecal immunochemical tests (FITs) for hemoglobin have emerged as better tests. gFOBTs are not sensitive to small bleeds, specificity can be affected by diet or drugs, participant acceptance can be low, laboratory quality control opportunities are limited, and they have a fixed hemoglobin concentration cutoff determining positivity. FITs are analytically more specific, capable of quantitation and hence provide flexibility to adjust cutoff concentration for positivity and the balance between sensitivity and specificity. FITs are clinically more sensitive for cancers and advanced adenomas, and because they are easier to use, acceptance rates are high. Conclusions: FOBT must be chosen carefully to meet the needs of the applicable screening scenario. Quantitative FIT can be adjusted to suit Scenarios 1, 2 and 3, and for each, they are the test of choice. FITs are superior to gFOBT for Scenario 4 and gFOBT is only suitable for Scenario 1.
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影响因子：
15.8
作者：
Elmunzer BJ;Hayward RA;Schoenfeld PS;Saini SD;Deshpande A;Waljee AK
通讯作者：
Waljee AK
影响因子：
39.2
作者：
Ahlquist DA;Sargent DJ;Loprinzi CL;Levin TR;Rex DK;Ahnen DJ;Knigge K;Lance MP;Burgart LJ;Hamilton SR;Allison JE;Lawson MJ;Devens ME;Harrington JJ;Hillman SL
通讯作者：
Hillman SL
影响因子：
12.6
作者：
Chiu, Han-Mo;Lee, Yi-Chia;Wu, Ming-Shiang
通讯作者：
Wu, Ming-Shiang
影响因子：
--
作者：
Deeks, JJ
通讯作者：
Deeks, JJ
影响因子：
10.3
作者：
Allison, James E.;Sakoda, Lori C.;Selby, Joseph V.
通讯作者：
Selby, Joseph V.