Abstract
BackgroundRepeated qualitative fecal immunochemical test (qlFIT) is a clinical strategy widely used to detect lower gastrointestinal lesions, but its diagnostic power has not been assessed in opportunistic screening for colorectal neoplasia.ObjectiveThis study aimed to determine the performance of three-sample qlFIT in screening for colorectal cancer and its precursors in high-risk participants.Methods513 gastrointestinal outpatients yielded three qlFITs before a standard colonoscopy. We evaluated the diagnostic value of one, two, and three positive qlFITs serving as the positivity threshold. The risk factors of colorectal neoplasia to yield positive qlFITs were also determined.Results52 patients were diagnosed with colorectal cancer and 70 with advanced adenomatous polyp. For colorectal cancer, the sensitivity and specificity of one positive qlFIT were 90.4% and 53.8%, of two were 80.8% and 75.1%, and of three were 53.9% and 88.5%, respectively. For advanced adenomatous polyp, the sensitivity and specificity of one positive qlFIT were 81.4% and 54.2%, of two were 50.0% and 72.5%, and of three were 28.6% and 86.2%. Left-sided location (OR 2.50, 95%CI 1.26–4.95) and advanced histology of tumors (OR 3.08, 95%CI 1.58–6.01) were independently associated with positive qlFITs.ConclusionsThree-sample qlFIT is a reasonably good method to detect colorectal neoplasia in high-risk population. Tumors in the left side or with advanced pathological features are more likely to produce positive qlFITs.
Highlights
Colorectal cancer (CRC) is the third most common cancer in men and the second in women worldwide, claiming 608,000 deaths in 2008 [1]
Some studies have confirmed the diagnostic effect of qualitative fecal immunochemical test (qlFIT) for colorectal neoplasia, but it is less clear if such efficacy is comparable to that of quantitative fecal immunochemical tests (qnFITs) [15,16,17,18]
This study aimed to determine the utility of three-sample qlFIT of separate bowel movements in: (i) identifying the presence of significant neoplasms (CRC or advanced adenoma) in high-risk patients having a scheduled colonoscopy; (ii) determining the number of colonoscopies that would have been needed because of positive qlFITs; and the number of colonoscopies that could have been postponed and (iii) the potential risk factors of colorectal neoplasia to yield positive qlFIT results
Summary
Ethics Statement: The Ethics Committee of Peking Union Medical College Hospital approved the study protocol, and people who met the inclusion criteria provided written informed consent. Study design This was a retrospective analysis of a prospective database. The location (right-sided, from the cecum to the splenic flexure; left-sided, the rest of the large bowel), size, number of lesions, and histological diagnosis of colorectal neoplasia were noted with reference to standard protocols. A pathologist with ten years of experience who was blinded to qlFIT results evaluated all the biopsied and resected tissues. A p value of less than 0.05 was considered of statistical significance
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