Well adjusted qualitative immunochemical faecal occult blood tests could be a promising alternative for inexpensive, high-quality colorectal cancer screening
Well adjusted qualitative immunochemical faecal occult blood tests could be a promising alternative for inexpensive, high-quality colorectal cancer screening
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DOI：
10.1097/cej.0b013e32835b6991
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发表时间：
2013-07-01
影响因子：
2.4
通讯作者：
Brenner, Hermann
中科院分区：
文献类型：
--
作者：
Tao, Sha;Brenner, Hermann
免疫化学粪便潜血试验（iFOBT）已被证明比传统的基于愈创木脂的粪便潜血试验具有更高的检测结直肠癌（CRC）及其前体的灵敏度，但成本更高，需要特定的实验室设备。已经开发了许多定性iFOBT，但由于用于测试阳性的阳性阈值变化很大，因此它们的性能差异很大。我们的目的是评估定性iFOBT的性能与良好调整的阳性阈值在筛选设置。在德国对229名接受筛查性结肠镜检查的参与者（45名CRC患者，65名晚期腺瘤患者和119名无结直肠肿瘤患者）进行的一项研究中，我们评估了两种定性iFOBT在五种不同阳性阈值下的性能，并将其与定量iFOBT的性能进行了比较。绘制受试者工作特征曲线。计算曲线下面积以及试验的灵敏度和特异性。对于这两种定性检测，晚期腺瘤的敏感性约为30%，CRC的敏感性约为80%，特异性水平非常高（98-99%）。与定量检测的受试者工作特征曲线的结果比较表明，定性检测在可比的特异性水平下产生了相似的高水平灵敏度。总之，通过适当调整阳性阈值，确保基于人群的筛查所需的特异性水平，基于办公室的定性iFOBT可以成为定量iFOBT的经济，定性可比的替代品。
Immunochemical faecal occult blood tests (iFOBTs) have been shown to have higher sensitivity to detect colorectal cancer (CRC) and its precursors than traditional guaiac-based faecal occult blood tests, but are more costly and require specific laboratory equipment. A number of qualitative iFOBTs have been developed, but their performance varied widely because of the large variation in positivity thresholds used for test positivity. We aimed to evaluate the performance of qualitative iFOBTs with well adjusted positivity thresholds in the screening setting. In a study of 229 participants who underwent screening colonoscopy in Germany (45 patients with CRC, 65 with advanced adenoma and 119 free of colorectal neoplasms), we evaluated the performance of two qualitative iFOBTs at five different positivity thresholds and compared it with the performance of a quantitative iFOBT. Receiver operating characteristic curves were constructed. The areas under the curve, and the sensitivity and specificity of the tests, were calculated. For both qualitative tests, sensitivities were around 30% for advanced adenoma and 80% for CRC at very high levels of specificity (98-99%). Comparison of results with the receiver operating characteristic curves for the quantitative test indicated that the qualitative tests yielded similarly high levels of sensitivity at comparable levels of specificity. In conclusion, with appropriate adjustment of positivity thresholds ensuring the levels of specificity required in population-based screening, qualitative, office-based iFOBTs can be an economic, qualitatively comparable alternative to quantitative iFOBTs.