FIT with fecal calprotectin detects advanced colorectal neoplasia
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The combination of fecal immunochemical test-based colonoscopy and fecal calprotectin detected advanced colorectal neoplasia, according to a presentation at Digestive Disease Week.
“Fecal immunochemical test (FIT)-based colonoscopy is widely accepted as a primary screening tool for colorectal cancer detection. However, FIT could be negative in some patients with advanced colorectal neoplasia (AN),” Ronakrit Thanhakun, Gastrointestinal Endoscopy Excellence Center, Chulalongkorn University and King Chulalongkorn Memorial Hospital, and colleagues wrote. “Therefore, we aimed to evaluate the diagnostic performance of combination between fecal biomarkers (fecal transferrin (Tf), fecal calprotectin (Cp) and fecal lactoferrin (Lf)) and FIT to improve AN detection.”
In a prospective study, researchers enrolled 457 asymptomatic participants (mean age 61.4 years; 75% women) from CRC screening clinics. Each participant underwent one-time qualitative FIT, Cp, Tf and Lf stool-based testing followed by colonoscopy. Researchers further compared the performance of FIT alone to FIT with Tf, FIT with Cp and FIT with Lf in the detection of AN.
According to study results, researchers found AN in 9.4% of participants and CRC in 1.1% of participants; the positivity rates were 20.6%, 49.9%, 66.3% and 10.3% for FIT, Cp, Tf and Lf, respectively. FIT alone demonstrated sensitivity of 55.8% for overall AN and sensitivity of 64.7% for proximal AN while researchers noted increased sensitivity for overall AN and proximal AN in FIT with Cp (81.4% and 82.4%, respectively), FIT with Tf (76.7% and 82.4%) and FIT with Lf (58.1% and 64.7%). For the detection of CRC, sensitivity of FIT, FIT with Cp, FIT with Tf and FIT with Lf was 80%, 80%, 100% and 80%, respectively. FIT alone and FIT with Cp could reduce 63% and 31% of unnecessary colonoscopies.
“The combination of FIT plus Cp is the most sensitive to detect AN among fecal biomarkers with the sensitivity increasing from 55.8% to 81.4%,” Thanhakun concluded. “However, further studies regarding cost effectiveness and long-term outcomes on reducing CRC incidence and mortality are warranted.”
Perspective
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The sensitivity of one-time fecal immunochemical test for detection of advanced neoplasia is low. Thanhakun and colleagues prospectively enrolled 457 asymptomatic patients undergoing screening colonoscopy who underwent stool testing for FIT, lactoferrin, transferrin and calprotectin prior to colonoscopy. The authors found that addition of fecal calprotectin improved sensitivity of advanced neoplasia detection from 81.4% compared with 55.8% for FIT alone. Results are promising and further studies are needed to validate the findings.
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Thahakun R, et al. Abstract 684. Presented at: Digestive Disease Week; May 21-23, 2021 (virtual meeting).
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