Identification of colorectal adenomas by a quantitative immunochemical faecal occult blood screening test depends on adenoma characteristics, development threshold used and number of tests performed

Autor:	Alexander Vilkin, Moshe Leshno, Zohar Levi, Paul Rozen, Yaron Niv, Rachel Hazazi, Eran Maoz, Shlomo Birkenfeld, Amal Waked
Rok vydání:	2009
Předmět:	Adenoma Male medicine.medical_specialty Adenomatous polyps Colonic Polyps Colonoscopy Colorectal adenoma Sensitivity and Specificity Gastroenterology Adenomatous Polyps Feces Hemoglobins Predictive Value of Tests Internal medicine medicine Humans Mass Screening Pharmacology (medical) Mass screening Aged Hepatology medicine.diagnostic_test business.industry Cancer Histology Middle Aged medicine.disease Immunohistochemistry digestive system diseases Occult Blood Predictive value of tests Female Colorectal Neoplasms business
Zdroj:	Alimentary Pharmacology & Therapeutics. 29:906-917
ISSN:	1365-2036 0269-2813
DOI:	10.1111/j.1365-2036.2009.03946.x
Popis:	Faecal occult blood tests (FOBT) are faulted by low sensitivity for advanced adenomatous polyps (AAP). Quantified, immunochemical, haemoglobin (Hb)-specific immunochemical FOBT (I-FOBT) measurements are now used for colorectal screening.To correlate adenoma characteristics to amount of faecal Hb lost and to evaluate sensitivity and specificity for AAP by faecal Hb development threshold used and number of I-FOBTs collected.Three daily I-FOBTs were collected and analysed in 1221 patients scheduled for colonoscopy. Faecal Hb was analysed as ngHb/mL of buffer and the highest result related to colonoscopy findings.In 1204 patients without cancer, colonoscopy identified adenomas in 294, 99 with AAPs. Adenoma patients had elevated faecal Hb increasing with advanced histology, size, pedunculated shape and multiplicity (P0.001 for all). At 50 ngHb/mL threshold, sensitivity and specificity for AAPs were 54.5% (95%CI 44.7, 64.7) and 88.1% (95%CI 86.2, 90.1) for three tests. At higher thresholds, sensitivity decreased, but was significantly higher with more samples collected. Conversely, specificity increased at higher thresholds, but decreased with more samples.Faecal Hb loss from adenomas is significantly associated with size, number and advanced features. Sensitivity and specificity for AAPs are determined by test threshold chosen and number of samples collected; these determine the number of colonoscopies needed for positive tests.
Databáze:	OpenAIRE
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