Abstract
Objective: The diagnostic efficiency of the quantitative fecal immunochemical test (qFIT) has large variations in colorectal cancer (CRC) screening. We aimed to explore whether the practical sample collection operant training could improve the diagnostic accuracy of the qFIT in CRC screening.Methods: Moderate-/high-risk individuals aged 50–75 years old were invited to participate in a prospective observational study between July 2020 and March 2021. Participants took a qFIT sample without fecal sample collection operant training in advance and then completed another qFIT sample after the operant training. The primary outcome was the sensitivity and specificity of the qFITs for CRC and advanced colorectal neoplasia (ACRN). The secondary outcome was the difference in the area under the curves (AUCs) and the concentrations of the fecal hemoglobin (Hb) between the qFIT without and after the operant training.Results: Out of 913 patients, 81 (8.9%) patients had ACRN, including 25 (2.7%) patients with CRC. For CRC, the sensitivities of the qFIT without and after the operant training at 10 μg/g were 80.4 and 100.0%, respectively, and the specificities were 90.1 and 88.4%, respectively. For ACRN, the sensitivities were 49.4 and 69.1% and the specificities were 91.7 and 91.3%, respectively. The AUC of the qFIT after the operant training was significantly higher than that without the operant training for CRC (p = 0.027) and ACRN (p = 0.001). After the operant training, the concentration of the fecal Hb was significantly higher than that without the operant training (p = 0.009) for ACRN, but there was no significant difference for CRC (p = 0.367).Conclusion: Practical sample collection operant training improves the diagnostic accuracy of the qFIT, which increases the detection of the low concentrations of fecal Hb. Improving the quality of the sample collection could contribute to the diagnostic efficiency of the qFIT in CRC screening.
Highlights
Colorectal cancer (CRC) is the third most common cancer worldwide [1] and the second most lethal cancer among the types of cancer [2]
The secondary outcome was the difference in the area under the curves (AUCs) for CRC and advanced colorectal neoplasia (ACRN) and the concentrations of the fecal Hb between the quantitative fecal immunochemical test (qFIT) without and after the operant training
913 patients who returned the qFIT samples and underwent the complete colonoscopy were included in the study analysis
Summary
Colorectal cancer (CRC) is the third most common cancer worldwide [1] and the second most lethal cancer among the types of cancer [2]. Detection is a well-recognized gamechanger for the effective prevention and treatment of CRC [3,4,5]. Colonoscopy is the golden standard for CRC, it is not applicable for screening a large population. The fecal immunochemical test (FIT), as a non-invasive and costeffective measure, is widely used for CRC screening [6]. The role of the FIT in identifying early CRC and lowering CRCassociated mortality has been validated in large cohorts [7,8,9]. The quantitative fecal immunochemical test (qFIT) is a laboratory-based testing method that automatically measures the concentration of the human hemoglobin (Hb) in the feces. In comparison to the qualitative FIT, qFIT can provide more information by selecting the optimal cutoff value to determine follow-up endoscopy [10,11,12]
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