BACKGROUND: Immunochemical tests show important advantages over chemical-based faecal occult blood tests (FOBT) for colorectal cancer (CRC) screening, but comparison studies are limited. This study was performed to compare the accuracy of a sensitive immunochemical test with the guaiac test for detecting significant neoplasia (advanced adenomas and CRC) in an average-risk population. METHODS: A random sample of 2288 asymptomatic subjects 50-79 years of age was prospectively included. Participants received three cards of the guaiac test, one sample of a latex-agglutination test (haemoglobin cut-off 50 ng/ml), and an invitation to undergo colonoscopy. Test sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated in 1756 compliers. RESULTS: Immunochemical and guaiac tests were positive in 143 (8.1%) and 62 (3.5%) subjects, respectively. Complete colonoscopy, performed in 402 participants (158 FOBT+ and 244 FOBT-), detected 14 (0.8%) patients with CRC and 49 (2.8%) with advanced adenomas. The immunochemical and guaiac tests for significant colorectal neoplasia showed sensitivities of 61% versus 23.8%, specificities of 95.1% versus 97.7%, PPVs of 43.4% versus 39.0%, and NPVs of 97.5% versus 95.4%, respectively. Proximal significant neoplasms were more frequently detected with the immunochemical test (85% vs. 15%) The relative risk for detecting significant neoplasia was superior in patients with a positive immunochemical test (RR 16.93; CI 7.94-36.10) than with a positive guaiac test (RR 3.34; CI 2.17-5.15). CONCLUSION: A sensitive immunochemical test is markedly superior to the guaiac test for detecting significant colorectal neoplasia, and should be considered the first-choice FOBT for CRC screening in the average-risk population.
BACKGROUND: Immunochemical tests show important advantages over chemical-based faecal occult blood tests (FOBT) for colorectal cancer (CRC) screening, but comparison studies are limited. This study was performed to compare the accuracy of a sensitive immunochemical test with the guaiac test for detecting significant neoplasia (advanced adenomas and CRC) in an average-risk population. METHODS: A random sample of 2288 asymptomatic subjects 50-79 years of age was prospectively included. Participants received three cards of the guaiac test, one sample of a latex-agglutination test (haemoglobin cut-off 50 ng/ml), and an invitation to undergo colonoscopy. Test sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated in 1756 compliers. RESULTS: Immunochemical and guaiac tests were positive in 143 (8.1%) and 62 (3.5%) subjects, respectively. Complete colonoscopy, performed in 402 participants (158 FOBT+ and 244 FOBT-), detected 14 (0.8%) patients with CRC and 49 (2.8%) with advanced adenomas. The immunochemical and guaiac tests for significant colorectal neoplasia showed sensitivities of 61% versus 23.8%, specificities of 95.1% versus 97.7%, PPVs of 43.4% versus 39.0%, and NPVs of 97.5% versus 95.4%, respectively. Proximal significant neoplasms were more frequently detected with the immunochemical test (85% vs. 15%) The relative risk for detecting significant neoplasia was superior in patients with a positive immunochemical test (RR 16.93; CI 7.94-36.10) than with a positive guaiac test (RR 3.34; CI 2.17-5.15). CONCLUSION: A sensitive immunochemical test is markedly superior to the guaiac test for detecting significant colorectal neoplasia, and should be considered the first-choice FOBT for CRC screening in the average-risk population.
Authors: Zohar Levi; Paul Rozen; Rachel Hazazi; Alex Vilkin; Amal Waked; Eran Maoz; Shlomo Birkenfeld; Moshe Leshno; Yaron Niv Journal: Ann Intern Med Date: 2007-02-20 Impact factor: 25.391
Authors: J D Hardcastle; J O Chamberlain; M H Robinson; S M Moss; S S Amar; T W Balfour; P D James; C M Mangham Journal: Lancet Date: 1996-11-30 Impact factor: 79.321
Authors: James E Allison; Lori C Sakoda; Theodore R Levin; Jo P Tucker; Irene S Tekawa; Thomas Cuff; Mary Pat Pauly; Lyle Shlager; Albert M Palitz; Wei K Zhao; J Sanford Schwartz; David F Ransohoff; Joseph V Selby Journal: J Natl Cancer Inst Date: 2007-09-25 Impact factor: 13.506
Authors: G Castiglione; P Sala; S Ciatto; G Grazzini; A Mazzotta; C Rossetti; P Spinelli; L Bertario Journal: Eur J Cancer Prev Date: 1994-09 Impact factor: 2.497
Authors: Jeffrey K Lee; Elizabeth G Liles; Stephen Bent; Theodore R Levin; Douglas A Corley Journal: Ann Intern Med Date: 2014-02-04 Impact factor: 25.391
Authors: Vicent Hernandez; Joaquin Cubiella; M Carmen Gonzalez-Mao; Felipe Iglesias; Concepción Rivera; M Begoña Iglesias; Lucía Cid; Ines Castro; Luisa de Castro; Pablo Vega; Jose Antonio Hermo; Ramiro Macenlle; Alfonso Martínez-Turnes; David Martínez-Ares; Pamela Estevez; Estela Cid; M Carmen Vidal; Angeles López-Martínez; Elisabeth Hijona; Marta Herreros-Villanueva; Luis Bujanda; Jose Ignacio Rodriguez-Prada Journal: World J Gastroenterol Date: 2014-01-28 Impact factor: 5.742
Authors: Douglas J Robertson; Jeffrey K Lee; C Richard Boland; Jason A Dominitz; Francis M Giardiello; David A Johnson; Tonya Kaltenbach; David Lieberman; Theodore R Levin; Douglas K Rex Journal: Am J Gastroenterol Date: 2016-10-18 Impact factor: 10.864