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Fecal immunochemical test was highly sensitive to colorectal cancer
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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, according to study results.
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 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 colorectal cancer 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 colorectal cancer, with 74 cases of advanced neoplasia and one of colorectal cancer detected via colonoscopy among the 1,135 negative results.
Analysis indicated an area under the curve of 0.70 (95% CI, 0.64-0.76) for detecting advanced neoplasia using FIT.
FIT50 demonstrated a 38% sensitivity and 93% specificity for advanced neoplasia, and an 88% sensitivity and 91% specificity for colorectal cancer.
FIT75 demonstrated a 33% sensitivity and 96% specificity for advanced neoplasia, and a 75% sensitivity and 93% specificity for colorectal cancer.
FIT100 demonstrated a 31% sensitivity and 97% specificity for advanced neoplasia, and a 75% sensitivity and 95% specificity for colorectal cancer.
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 colorectal cancer 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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de Wijkerslooth TR. Am J Gastroenterol. 2012;doi:10.1038/ajg.2012.249.
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