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Sensitivity of immunochemical faecal occult blood testing for detecting left- vs right-sided colorectal neoplasia.

Haug U, Kuntz KM, Knudsen AB, Hundt S, Brenner H - Br. J. Cancer (2011)

Bottom Line: Faecal occult blood tests (FOBTs) are used for colorectal cancer (CRC) screening.In logistic regression analyses adjusted for site, pedunculated shape was statistically significantly associated with test sensitivity (P=0.04).Our findings may stimulate further diagnostic research in the field as well as modelling analyses to estimate the potential effect of site-specific test performance on the effectiveness of annual or biennial FOBT-based screening programmes, in particular with respect to protection from right-sided CRC.

View Article: PubMed Central - PubMed

Affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 460, Heidelberg 69120, Germany. u.haug@dkfz.de

ABSTRACT

Background: Faecal occult blood tests (FOBTs) are used for colorectal cancer (CRC) screening. We aimed to assess the sensitivity of an immunochemical FOBT for detecting advanced colorectal neoplasia in the left vs the right colon and to explore reasons for potential differences in site-specific test performance.

Methods: We prospectively measured faecal occult blood levels by a quantitative immunochemical FOBT (RIDASCREEN) in 2310 average-risk subjects undergoing screening colonoscopy. We compared diagnostic performance for subjects with left- vs right-sided advanced neoplasia, as well as patient characteristics and adenoma characteristics that have been suggested to impact faecal haemoglobin levels.

Results: Sensitivities for subjects with left- vs right-sided advanced neoplasia were 33% (95% confidence interval (CI), 26-41%) and 20% (CI, 11-31%) (P=0.04) at a specificity of 95% (overall sensitivity: 29%) and the areas under the receiver-operating characteristics curve were 0.71 (CI, 0.69-0.72) and 0.60 (CI, 0.58-0.63), respectively. Pedunculated shape was strikingly more common in participants with left- vs right-sided advanced neoplasia (47% vs 14%). In logistic regression analyses adjusted for site, pedunculated shape was statistically significantly associated with test sensitivity (P=0.04).

Conclusions: The immunochemical FOBT in our study was more sensitive for detecting subjects with left- vs right-sided advanced colorectal neoplasia. Our findings may stimulate further diagnostic research in the field as well as modelling analyses to estimate the potential effect of site-specific test performance on the effectiveness of annual or biennial FOBT-based screening programmes, in particular with respect to protection from right-sided CRC.

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Related in: MedlinePlus

Standards for reporting of diagnostic accuracy (STARD) flow diagram.
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fig1: Standards for reporting of diagnostic accuracy (STARD) flow diagram.

Mentions: As illustrated in Figure 1, we made the following consecutive exclusions to ensure that study participants represent the average-risk target population of CRC screening and to minimise potential misclassification due to missed lesions on colonoscopy: visible rectal bleeding or previous positive FOBT result (n=157), inflammatory bowel disease (n=15), colonoscopy in the previous 5 years (n=179), stool sampling after colonoscopy (n=88), incomplete colonoscopy (n=37) and inadequate bowel preparation for colonoscopy (n=126). In addition, we excluded 91 participants with pseudopolyps or histologically undefined polyps at screening colonoscopy. Another 59 participants had to be excluded due to missing of a suitable stool sample. Among the remaining 2325 participants potentially eligible to be included in the analyses, we excluded 15 participants who were diagnosed with advanced colorectal neoplasia both in the left and in the right colon.


Sensitivity of immunochemical faecal occult blood testing for detecting left- vs right-sided colorectal neoplasia.

Haug U, Kuntz KM, Knudsen AB, Hundt S, Brenner H - Br. J. Cancer (2011)

Standards for reporting of diagnostic accuracy (STARD) flow diagram.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3111170&req=5

fig1: Standards for reporting of diagnostic accuracy (STARD) flow diagram.
Mentions: As illustrated in Figure 1, we made the following consecutive exclusions to ensure that study participants represent the average-risk target population of CRC screening and to minimise potential misclassification due to missed lesions on colonoscopy: visible rectal bleeding or previous positive FOBT result (n=157), inflammatory bowel disease (n=15), colonoscopy in the previous 5 years (n=179), stool sampling after colonoscopy (n=88), incomplete colonoscopy (n=37) and inadequate bowel preparation for colonoscopy (n=126). In addition, we excluded 91 participants with pseudopolyps or histologically undefined polyps at screening colonoscopy. Another 59 participants had to be excluded due to missing of a suitable stool sample. Among the remaining 2325 participants potentially eligible to be included in the analyses, we excluded 15 participants who were diagnosed with advanced colorectal neoplasia both in the left and in the right colon.

Bottom Line: Faecal occult blood tests (FOBTs) are used for colorectal cancer (CRC) screening.In logistic regression analyses adjusted for site, pedunculated shape was statistically significantly associated with test sensitivity (P=0.04).Our findings may stimulate further diagnostic research in the field as well as modelling analyses to estimate the potential effect of site-specific test performance on the effectiveness of annual or biennial FOBT-based screening programmes, in particular with respect to protection from right-sided CRC.

View Article: PubMed Central - PubMed

Affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 460, Heidelberg 69120, Germany. u.haug@dkfz.de

ABSTRACT

Background: Faecal occult blood tests (FOBTs) are used for colorectal cancer (CRC) screening. We aimed to assess the sensitivity of an immunochemical FOBT for detecting advanced colorectal neoplasia in the left vs the right colon and to explore reasons for potential differences in site-specific test performance.

Methods: We prospectively measured faecal occult blood levels by a quantitative immunochemical FOBT (RIDASCREEN) in 2310 average-risk subjects undergoing screening colonoscopy. We compared diagnostic performance for subjects with left- vs right-sided advanced neoplasia, as well as patient characteristics and adenoma characteristics that have been suggested to impact faecal haemoglobin levels.

Results: Sensitivities for subjects with left- vs right-sided advanced neoplasia were 33% (95% confidence interval (CI), 26-41%) and 20% (CI, 11-31%) (P=0.04) at a specificity of 95% (overall sensitivity: 29%) and the areas under the receiver-operating characteristics curve were 0.71 (CI, 0.69-0.72) and 0.60 (CI, 0.58-0.63), respectively. Pedunculated shape was strikingly more common in participants with left- vs right-sided advanced neoplasia (47% vs 14%). In logistic regression analyses adjusted for site, pedunculated shape was statistically significantly associated with test sensitivity (P=0.04).

Conclusions: The immunochemical FOBT in our study was more sensitive for detecting subjects with left- vs right-sided advanced colorectal neoplasia. Our findings may stimulate further diagnostic research in the field as well as modelling analyses to estimate the potential effect of site-specific test performance on the effectiveness of annual or biennial FOBT-based screening programmes, in particular with respect to protection from right-sided CRC.

Show MeSH
Related in: MedlinePlus