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FIT accurately detects CRC, equally sensitive to proximal, distal advanced neoplasia
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Fecal immunochemical testing was highly sensitive to colorectal cancer and moderately but equally sensitive to proximally- and distally-located advanced neoplasia in a recent study.
Fecal immunochemical testing (FIT) and colonoscopy were performed on 1,256 participants randomly invited to participate. FIT tests were performed by participants at home, within 48 hours of colonoscopy, prior to bowel preparation. Sensitivity, specificity and predictive value of FIT in detecting colorectal cancer (CRC) and advanced neoplasia were measured at cutoff values of 50 ng Hb/ml (FIT50), 75 ng Hb/ml (FIT75) and 100 ng Hb/ml (FIT100).
Colonoscopy detected advanced neoplasia in 119 patients and CRC in eight. FIT testing indicated positive results among 121 patients at the FIT50 cutoff, 88 at FIT75 and 71 at FIT100. The FIT50 results included 45 incidences of advanced neoplasia and seven of CRC, with 74 cases of advanced neoplasia and one of CRC detected via colonoscopy among the 1,135 negative results.
ROC analysis indicated an AUC of 0.70 (95% CI, 0.64-0.76) for detecting advanced neoplasia using FIT. Sensitivity and specificity were estimated as the following for the three cutoff values (95% CI for all):
- FIT50: Sensitivity 38% (29-47%), specificity 93% (92-95%) for advanced neoplasia; 88% (47-99%) and 91% (89-92%) for CRC
- FIT75: Sensitivity 33% (25-42%), specificity 96% (94-97%) for advanced neoplasia; 75% (36-96%) and 93% (92-95%) for CRC
- FIT100: Sensitivity 31% (23-40%), specificity 97% (96-98%) for advanced neoplasia; 75% (36-96%) and 95% (93-96%) for CRC
Among the 119 incidences of advanced neoplasia, isolated proximal neoplasias were detected in 24 participants and isolated distal neoplasias were present in 83 participants. Sensitivity toward proximal vs. distal neoplasia was similar across all three cutoff values: 38% vs. 37%, for FIT50 (P=.99); 33% vs. 31% for FIT75 (P=.85), and 33% vs. 29% for FIT100 (P=.68).
“This study shows that FIT has a high sensitivity in the detection of CRC and a moderate sensitivity in detecting advanced neoplasia within an invitational colonoscopy screening program,” the researchers concluded. “In contrast to previous findings, the sensitivity of FIT in detecting proximal and distal advanced neoplasia is equal.”
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