Colorectal cancer screening: Comparison of transferrin and immuno fecal occult blood test
Colorectal cancer screening: Comparison of transferrin and immuno fecal occult blood test
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结直肠癌筛查：转铁蛋白与免疫粪便潜血试验的比较
DOI：
10.3748/wjg.v18.i21.2682
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发表时间：
2012-06-07
影响因子：
4.3
通讯作者：
Yuan, Xiang-Lin
中科院分区：
文献类型：
--
作者：
Chen, Ji-Gui;Cai, Juan;Yuan, Xiang-Lin
目的：目的：探讨免疫组织化学法检测大肠癌（CRC）及癌前病变的敏感性和特异性。611人随后接受了三次粪便潜血试验和结肠镜检查，并根据需要进行活检。在结肠镜检查前一天采集粪便样本。对同一粪便同时进行Tf、免疫粪隐血试验（IFOBT）和愈创木脂粪隐血试验（g-FOBT）。为了尽量减少假阴性病例，要求所有阴性样本的受试者提供额外的粪便标本进行第二次检测，甚至第三次检测。如果检测三份重复样本后结果均为阴性，则认为受试者为真阴性。比较Tf与IFOBT及Tf、IFOBT和g-FOBT联合检测CRC和癌前病变的性能特点。结果：共有611例受试者符合研究标准，其中CRC 25例，癌前病变60例。Tf和IFOBT诊断结直肠癌的敏感性分别为92%和96%，特异性均为72.0%（95% CI：68.2%~ 75.5%; chi（2）= 0.4，P > 0.05），阳性似然比分别为3.3（95% CI：2.8-3.9）和3.4（95% CI：2.9-4.0）。在癌前病变中，Tf和IFOBT的敏感性分别为50%和58 Tf和IFOBT的特异性均为71.5%（2，2 = 0.8，P > 0.05）（95% CI：67.6%-75.1%）和72.2%（95% CI：68.4%-75.8%）;阳性似然比为1.8（95%CI：1.3-2.3）和2.1（95%CI：1.6-2.7）;与IFOBT相比，g-FOBT+ Tf+ IFOBT对癌前病变的阳性率显著更高（分别为83%vs58%，chi（2）= 9.1，P > 0.05）。在结直肠癌和癌前病变中，Tf和IFOBT的敏感性分别为62%和69%（χ 2 = 0.9，P > 0.05），特异性为74.5%（95% CI：70.6%-78.1%）和75.5%（95% CI：71.6%-79.0%）;阳性似然比分别为2.5（95% CI：2.0-3.1）和2.8（95% CI：2.3-3.5）。与IFOBT单独检测相比，g-FOBT、IFOBT和Tf联合检测对结直肠癌和癌前病变的敏感性显著提高（分别为69%vs88%，χ 2 = 9.0，P < 0.05）。结论：Tf试纸条检测可作为结直肠癌和癌前病变的一种筛查方法。(C)2012年百世登。All rights reserved.
AIM: To evaluate the sensitivity and specificity of transfesrrin dipstick test (Tf) in colorectal cancer (CRC) screening and precancerous lesions screening.METHODS: Eight hundreds and sixty-one individuals at high-risk for CRC were recruited. Six hundreds and eleven subsequently received the three fecal occult blood tests and colonoscopy with biopsy performed as needed. Fecal samples were obtained on the day before colonoscopy. Tf, immuno fecal occult blood test (IFOBT) and guaiac fecal occult blood test (g-FOBT) were performed simultaneously on the same stool. To minimize false-negative cases, all subjects with negative samples were asked to provide an additional stool specimen for a second test even a third test. If the results were all negative after testing three repeated samples, the subject was considered a true negative. The performance characteristics of Tf for detecting CRC and precancerous lesions were examined and compared to those of IFOBT and the combination of Tf, IFOBT and g-FOBT.RESULTS: A total of six hundreds and eleven subjects met the study criteria including 25 with CRC and 60 with precancerous lesions. Sensitivity for detecting CRC was 92% for Tf and 96% for IFOBT, specificities of Tf and IFOBT were both 72.0% (95% CI: 68.2%-75.5%; chi(2) = 0.4, P > 0.05); positive likelihood ratios of those were 3.3 (95% CI: 2.8-3.9) and 3.4 (95% CI: 2.9-4.0), respectively. In precancerous lesions, sensitivities for Tf and IFOBT were 50% and 58%, respectively (2,2 = 0.8, P > 0.05); specificities of Tf and IFOBT were 71.5% (95% CI: 67.6%-75.1%) and 72.2% (95% CI: 68.4%-75.8%); positive likelihood ratios of those were 1.8 (95% CI: 1.3-2.3) and 2.1 (95% CI: 1.6-2.7), respectively; compared to IFOBT, g-FOBT+ Tf+ IFOBT had a significantly higher positive rate for precancerous lesions (83% vs 58%, respectively; chi(2) = 9.1, P > 0.05). In patients with CRC and precancerous lesions, the sensitivities of Tf and IFOBT were 62% and 69% (chi(2) = 0.9, P > 0.05); specificities of those were 74.5% (95% CI: 70.6%-78.1%) and 75.5% (95% CI: 71.6%-79.0%); positive likelihood ratios of those were 2.5 (95% CI: 2.0-3.1) and 2.8 (95% CI: 2.3-3.5). Compared to IFOBT alone, combining g-FOBT, IFOBT and Tf led to significantly increased sensitivity for detecting CRC and cancerous lesions (69% vs 88%, respectively; chi(2) = 9.0, P < 0.05).CONCLUSION: Tf dipstick test might be used as an additional tool for CRC and precancerous lesions screening in a high-risk cohort. (C) 2012 Baishideng. All rights reserved.