RSS-Feed abonnieren
DOI: 10.1055/s-0034-1392412
Fecal immunochemical testing results and characteristics of colonic lesions
Publikationsverlauf
submitted 20. August 2014
accepted after revision 01. April 2015
Publikationsdatum:
30. Juni 2015 (online)
Background and study aims: Fecal immunochemical tests (FIT) are used to detect blood in feces, which might indicate the presence of colorectal neoplasia. The aim of this study was to investigate whether FIT results vary depending on the characteristics of colonic lesions.
Patients and methods: This was a retrospective analysis of lesions detected in a cohort of asymptomatic individuals (aged 50 – 75 years) who were invited to participate in a FIT-based screening pilot in The Netherlands. The mean FIT result was compared across subgroups of individuals defined by histopathology of the most advanced lesion detected. In addition, the results were compared with data from a primary colonoscopy screening trial, in which participants also completed a FIT.
Results: In three rounds of FIT-based screening, a total of 877 FIT-positive individuals underwent colonoscopy. Higher mean FIT results (hemoglobin [Hb]/g feces) were observed in individuals with carcinomas (199 μg Hb/g) and advanced adenomas (87 μg Hb/g) compared with participants with nonadvanced adenomas (50 μg Hb/g) or those with serrated lesions (46 μg Hb/g) (P < 0.001). In the primary colonoscopy trial, 1256 participants completed a FIT test and underwent colonoscopy. The number of participants with nonadvanced adenomas as the most advanced lesion was comparable between this group and the FIT-based screening group (20 % vs. 22 %).
Conclusion: In FIT-based screening, the mean FIT results varied depending on the characteristics of the most advanced colonic lesion. The proportion of participants with a nonadvanced adenoma as the most advanced lesion was similar in the FIT-based screening group and in the primary colonoscopy screening group, suggesting that these lesions are coincidental findings rather than FIT-detected findings.
Clinical trial registration: www.trialregister.nl number NTR2755.
-
References
- 1 Zavoral M. Colorectal cancer screening in Europe. World J Gastroenterol 2009; 15: 5907
- 2 Libby G, Brewster DH, McClements PL et al. The impact of population-based faecal occult blood test screening on colorectal cancer mortality: a matched cohort study. Br J Cancer 2012; 107: 255-259
- 3 Van Rossum LG, Van Rijn AF, Laheij RJ et al. Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population. Gastroenterology 2008; 135: 820
- 4 Hol L, Wilschut JA, van Ballegooijen M et al. Screening for colorectal cancer: random comparison of guaiac and immunochemical faecal occult blood testing at different cut-off levels. Br J Cancer 2009; 100: 1103-1110
- 5 van Rossum LG, van Rijn AF, Laheij RJ et al. Cutoff value determines the performance of a semi-quantitative immunochemical faecal occult blood test in a colorectal cancer screening programme. Br J Cancer 2009; 101: 1274-1281
- 6 Van Roon AHC, Hol L, Van Vuuren AJ et al. Are fecal immunochemical test characteristics influenced by sample return time? A population-based colorectal cancer screening trial.. Am J Gastroenterol 2012; 107: 99-107
- 7 Fraser CG, Allison JE, Halloran SP et al. A proposal to standardize reporting units for fecal immunochemical tests for hemoglobin. J Natl Cancer Inst 2012; 104: 810-814
- 8 van Turenhout ST, van Rossum LG, Oort FA et al. Similar fecal immunochemical test results in screening and referral colorectal cancer. World J Gastroenterol 2012; 18: 5397-5403
- 9 Rozen P, Levi Z, Hazazi R et al. 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. Aliment Pharmacol Ther 2009; 29: 906-917
- 10 Levi Z, Rozen P, Hazazi R et al. A quantitative immunochemical fecal occult blood test for colorectal neoplasia. Ann Intern Med 2007; 146: 244-255
- 11 Cubiella J, Castro I, Hernandez V et al. Characteristics of adenomas detected by fecal immunochemical test in colorectal cancer screening. Cancer Epidemiol Biomarkers Prev 2014; 23: 1884-1892
- 12 Digby J, Fraser CG, Carey FA et al. Faecal haemoglobin concentration is related to severity of colorectal neoplasia. J Clin Pathol 2013; 66: 415-419
- 13 Denters MJ, Deutekom M, Bossuyt PM et al. Lower risk of advanced neoplasia among patients with a previous negative result from a fecal test for colorectal cancer. Gastroenterology 2012; 142: 497-504
- 14 Stegeman I, de Wijkerslooth TR, Mallant-Hent RC et al. Implementation of population screening for colorectal cancer by repeated fecal immunochemical test (FIT): third round. BMC Gastroenterol 2012; 12: 73
- 15 Denters MJ, Deutekom M, Fockens P et al. Implementation of population screening for colorectal cancer by repeated fecal occult blood test in The Netherlands. BMC Gastroenterol 2009; 9: 28
- 16 De Wijkerslooth TR, Stoop EM, Bossuyt PM et al. Immunochemical fecal occult blood testing is equally sensitive for proximal and distal advanced neoplasia. Am J Gastroenterol 2012; 107: 1570-1578
- 17 Stoop EM, de Haan MC, de Wijkerslooth TR et al. Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomised controlled trial. Lancet Oncol 2012; 13: 55-64
- 18 De Wijkerslooth TR, de Haan MC, Stoop EM et al. Burden of colonoscopy compared to non-cathartic CT-colonography in a colorectal cancer screening programme: randomised controlled trial. Gut 2012; 61: 1552-1559
- 19 Schlemper RJ, Riddell RH, Kato Y et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
- 20 Snover DC, Ahnen DJ, Burt RW, Odze RD. Serrated polyps of the colon and rectum and serrated polyposis. In: Bosman FT, Carneiro F, Hruban RH, et al. (eds.) WHO classification of tumours of the digestive system. France: Lyon: IARC; 2010: 160-165
- 21 Kim KH, Yang SS, Yoon YS et al. Validation of the seventh edition of the American Joint Committee on Cancer tumor-node-metastasis (AJCC TNM) staging in patients with stage II and stage III colorectal carcinoma: analysis of 2511 cases from a medical centre in Korea. Colorectal Dis 2011; 13: e220-226
- 22 Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010; 17: 1471-1474
- 23 Endoscopic Classification Review Group. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005; 37: 570-578
- 24 Liao C-S, Lin Y-M, Chang H-C et al. Application of quantitative estimates of fecal hemoglobin concentration for risk prediction of colorectal neoplasia. World J Gastroenterol 2013; 19: 8366-8372
- 25 Haug U, Kuntz KM, Knudsen AB et al. Sensitivity of immunochemical faecal occult blood testing for detecting left- vs right-sided colorectal neoplasia. Br J Cancer 2011; 104: 1779-1785
- 26 Stegeman I, de Wijkerslooth TR, Stoop EM et al. Risk factors for false positive and for false negative test results in screening with fecal occult blood testing. Int J Cancer 2013; 133: 2408-2414
- 27 Stegeman I, de Wijkerslooth TR, Stoop EM et al. Combining risk factors with faecal immunochemical test outcome for selecting CRC screenees for colonoscopy. Gut 2014; 63: 466-471