Comparative Evaluation of Immunochemical Fecal Occult Blood Tests for Colorectal Adenoma Detection
Comparative Evaluation of Immunochemical Fecal Occult Blood Tests for Colorectal Adenoma Detection
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DOI：
10.7326/0003-4819-150-3-200902030-00005
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发表时间：
2009-02-03
影响因子：
39.2
通讯作者：
Brenner, Hermann
中科院分区：
文献类型：
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作者：
Hundt, Sabrina;Haug, Ulrike;Brenner, Hermann
背景：不同的免疫化学粪便潜血试验（FOBT）已被提出用于非侵入性结直肠癌筛查。大规模的，基于结肠镜的筛查研究，可以评估这些测试的检测前体lesions.Objective：为了确定和比较的性能特点，6定性免疫化学FOBT识别结直肠腺瘤的成年人谁参加筛查结肠镜examines.Design：前瞻性筛查研究，从2006年1月至2007年12月。德国20家进行结肠镜检查的胃肠病学诊所。患者：1319名有结肠直肠肿瘤平均风险的参与者，他们正在接受结肠镜检查（平均年龄63岁; 50%为男性）。测量：在结肠镜检查的肠道准备前，对收集的粪便样本进行6种不同的定性免疫化学FOBT。通过将检测结果与结肠镜检查结果进行比较，测量检测的性能特征（灵敏度、特异性、预测值和似然比）。技术人员谁读测试是盲目的结肠镜检查结果，结肠镜检查是盲目的FOBT results.Results：总体而言，405名参与者（31%）有腺瘤和130名参与者（10%）有一个先进的腺瘤。测试中的性能特征差异很大。对于2项性能最佳的测试（immoCARE-C [ CAREdiagnostica，Voerde，德国]和FOB advanced [ulti med，Ahrensburg，德国]），检测晚期腺瘤的灵敏度为25%（95% CI，18%至34%）和27%（CI，20%至35%）;特异性为97%（CI，95%至98%）和93%（CI，91%至95%）;阳性似然比为3.5（CI，2.2至5.4）和2.5（CI，1.9至3.5）。局限性：该研究与现实生活条件不同，因为粪便样本未直接溶解在缓冲液填充的小瓶中;相反，一个小容器被使用，粪便被冷冻前testing.Conclusion：定性免疫化学FOBTs可能是未来的结直肠癌筛查的一种选择，因为它们表现出更好的性能特征比愈创木脂为基础的FOBTs的前驱病变，是实用的大规模筛查。然而，鉴于测试之间的诊断性能差异很大，仔细评估不同的测试变体是重要的。
Background: Different immunochemical fecal occult blood tests (FOBTs) have been proposed for noninvasive colorectal cancer screening. Large-scale, colonoscopy-based screening studies that allow evaluation of these tests for the detection of precursor lesions are scarce.Objective: To determine and compare performance characteristics of 6 qualitative immunochemical FOBTs for identifying colorectal adenomas among adults who attended screening colonoscopy examinations.Design: Prospective screening study from January 2006 to December 2007.Setting: 20 gastroenterology practices in Germany that did screening colonoscopy.Patients: 1319 participants at average risk for colorectal neoplasia who were undergoing screening colonoscopy (mean age, 63 years; 50% men).Measurements: 6 different qualitative immunochemical FOBTs were done with stool samples collected before bowel preparation for colonoscopy. Performance characteristics (sensitivity, specificity, predictive values, and likelihood ratios) of tests were measured by comparing test results with findings on colonoscopy. Technicians who read the tests were blinded to colonoscopy results, and colonoscopists were blinded to FOBT results.Results: Overall, 405 participants (31%) had an adenoma and 130 participants (10%) had an advanced adenoma. Performance characteristics varied widely among tests. For the 2 best-performing tests (immoCARE-C [ CAREdiagnostica, Voerde, Germany] and FOB advanced [ulti med, Ahrensburg, Germany]), the sensitivity for detection of advanced adenomas was 25% (95% CI, 18% to 34%) and 27% (CI, 20% to 35%), respectively; specificity was 97% (CI, 95% to 98%) and 93% (CI, 91% to 95%); and the positive likelihood ratio was 3.5 (CI, 2.2 to 5.4) and 2.5 (CI, 1.9 to 3.5).Limitation: The study differed from real-life conditions in that stool samples were not directly dissolved in a buffer-filled vial; instead, a small container was used and stool was frozen before testing.Conclusion: Qualitative immunochemical FOBTs could be an option for future colorectal cancer screening because they showed better performance characteristics for precursor lesions than guaiac-based FOBTs and are practical for mass screening. However, given the large differences in diagnostic performance among tests, careful evaluation of the different test variants is important.