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Quintero E, Gimeno-García AZ. Colorectal Cancer Screening in the Non-Syndromic Familial Risk Population: Is It Time to Revise the Clinical Guidelines? Am J Gastroenterol 2017; 112:1774-1776. [PMID: 29087400 DOI: 10.1038/ajg.2017.403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Enrique Quintero
- Servicio de Gastroenterología, Hospital Universitario de Canarias, La Laguna University, La Laguna, Tenerife, Spain.,Instituto Universitario de Tecnologías Biomédicas (ITB) and Centro de Investigación Biomédica de Canarias (CIBICAN), La Laguna, Tenerife, Spain.,Departamento de Medicina Interna, La Laguna, Tenerife, Spain
| | - Antonio Z Gimeno-García
- Servicio de Gastroenterología, Hospital Universitario de Canarias, La Laguna University, La Laguna, Tenerife, Spain.,Instituto Universitario de Tecnologías Biomédicas (ITB) and Centro de Investigación Biomédica de Canarias (CIBICAN), La Laguna, Tenerife, Spain
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Katsoula A, Paschos P, Haidich AB, Tsapas A, Giouleme O. Diagnostic Accuracy of Fecal Immunochemical Test in Patients at Increased Risk for Colorectal Cancer: A Meta-analysis. JAMA Intern Med 2017; 177. [PMID: 28628706 PMCID: PMC5710432 DOI: 10.1001/jamainternmed.2017.2309] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE The potential role of the fecal immunochemical test (FIT) for screening patients at increased risk for colorectal cancer (CRC) has not yet been elucidated. OBJECTIVE To assess the diagnostic accuracy of FIT for CRC or advanced neoplasia (AN) in asymptomatic patients at above-average risk. DATA SOURCES MEDLINE, EMBASE, Cochrane Library, and gray literature sources through August 2016. STUDY SELECTION Diagnostic studies evaluating the accuracy of FIT for CRC or AN in patients with a personal or familial history of CRC using colonoscopy as the reference standard. DATA EXTRACTION AND SYNTHESIS Two authors (A.K. and P.P.) independently extracted data and evaluated study quality using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, and evaluated the quality of the body of evidence by means of GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Hierarchical models were used to synthesize available evidence. MAIN OUTCOMES AND MEASURES The primary outcome was the diagnostic performance of FIT for detecting CRC or AN. RESULTS We included 12 studies (6204 participants). Seven studies were deemed at high or unclear risk of bias. The average sensitivity of FIT for CRC was 93% (95% CI, 53%-99%), and the average specificity was 91% (95% CI, 89%-92%), yielding a positive likelihood ratio (LR+) of 10.30 (CI 7.7-13.9) and a negative likelihood ratio (LR-) of 0.08 (95% CI, 0.01-0.75) (GRADE: very low). The average sensitivity of FIT for AN was 48% (95% CI, 39%-57%); and the average specificity was 93% (95% CI, 91%-94%), yielding an LR+ of 6.55 (95% CI, 5.0-8.5) and an LR- of 0.57 (95% CI, 0.48-0.67) (GRADE: very low). Subgroup analyses indicated that FIT cutoff values between 15- and 25-μg/g feces provided the best combination of sensitivity and specificity for the diagnosis of CRC (93% and 94%, respectively). Quantitative and 1-sample FIT showed adequate test performance, but data on other FIT brands and multiple samples were insufficient. CONCLUSIONS AND RELEVANCE The FIT has high overall diagnostic accuracy for CRC but moderate accuracy for AN in patients at above-average personal or familial risk. Heterogeneity and wide confidence intervals limit the trustworthiness of our findings.
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Affiliation(s)
- Anastasia Katsoula
- Second Propedeutic Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paschalis Paschos
- Second Propedeutic Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene and Epidemiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Harris Manchester College, University of Oxford, Oxford, United Kingdom
| | - Olga Giouleme
- Second Propedeutic Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Banaszkiewicz Z, Budzyński J, Tojek K, Jarmocik P, Frasz J, Mrozowski M, Świtoński M, Jawień A. The fecal occult blood test as a tool for improved outpatient qualification for colonoscopy. A single-center experience and 10-year follow-up survey. Adv Med Sci 2017; 62:171-176. [PMID: 28282604 DOI: 10.1016/j.advms.2016.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 07/29/2016] [Accepted: 08/01/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE Colonoscopy is not widely and easily available in all countries, even for symptomatic patients. This is one of the causes of tumors not being diagnosed until an advanced stage. The aim of this study was to estimate the efficacy of the fecal occult blood test (FOBT) in the diagnostic work-up of outpatients referred to a colorectal unit due to indistinct abdominal symptoms. PATIENTS/METHODS Among 10418 consecutive symptomatic individuals referred to the outpatient clinic, an immunochemical FOBT (Hem-Check 1®) was recommended for 9432 patients with indistinct symptoms as a tool for qualifying them for colonoscopy. All the subjects were treated according to their diagnosis and followed-up for the next 10 years. RESULTS Colorectal cancer (CRC) was diagnosed in 535 individuals: 393/986 (39.9%) among patients with red-flag symptoms, and 142/951 (14.9%) of individuals with indistinct symptoms and a positive FOBT. In the latter group, less-advanced tumors, classed as such using Dukes' classification, were twice as common and more advanced CRC occurred twice as seldom than in the former. Cancer recurrence-free and overall survival periods after surgical treatment for CRC were significantly longer in patients with indistinct symptoms who qualified for diagnostic procedures on the basis of a positive FOBT. CONCLUSIONS Patients with symptoms suggesting organic colon disease had a worse prognosis compared to individuals with non-specific symptoms. If bowel endoscopy is not widely and easily available, qualification for colonoscopy on the basis of alarm symptoms and a positive FOBT seems to be an effective strategy in early CRC diagnosis.
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Affiliation(s)
- Zbigniew Banaszkiewicz
- Department of General, Gastrointestinal, Colorectal and Oncological Surgery, Chair of Vascular Surgery and Angiology, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland; Department of General, Gastrointestinal, Colorectal and Oncological Surgery, Jan Biziel University Hospital No. 2 in Bydgoszcz, Poland
| | - Jacek Budzyński
- Chair of Vascular and Internal Diseases, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland.
| | - Krzysztof Tojek
- Department of General, Gastrointestinal, Colorectal and Oncological Surgery, Jan Biziel University Hospital No. 2 in Bydgoszcz, Poland
| | - Paweł Jarmocik
- Department of General, Gastrointestinal, Colorectal and Oncological Surgery, Jan Biziel University Hospital No. 2 in Bydgoszcz, Poland
| | - Jacek Frasz
- Department of General, Gastrointestinal, Colorectal and Oncological Surgery, Jan Biziel University Hospital No. 2 in Bydgoszcz, Poland
| | - Marcin Mrozowski
- Department of General, Gastrointestinal, Colorectal and Oncological Surgery, Jan Biziel University Hospital No. 2 in Bydgoszcz, Poland
| | - Maciej Świtoński
- Department of General, Gastrointestinal, Colorectal and Oncological Surgery, Jan Biziel University Hospital No. 2 in Bydgoszcz, Poland
| | - Arkadiusz Jawień
- Department of General, Gastrointestinal, Colorectal and Oncological Surgery, Chair of Vascular Surgery and Angiology, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland; Chair of Vascular Surgery and Angiology, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland
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Terhaar sive Droste JS, van Turenhout ST, Oort FA, van der Hulst RWM, Steeman VA, Coblijn U, van der Eem L, Duijkers R, Bouman AA, Meijer GA, Depla ACTM, Scholten P, Loffeld RJLF, Coupé VMH, Mulder CJJ. Faecal immunochemical test accuracy in patients referred for surveillance colonoscopy: a multi-centre cohort study. BMC Gastroenterol 2012; 12:94. [PMID: 22828158 PMCID: PMC3444435 DOI: 10.1186/1471-230x-12-94] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 07/24/2012] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Given the increasing burden on colonoscopy capacity, it has been suggested that faecal immunochemical test (FIT) results could guide surveillance colonoscopy intervals. Against this background, we have evaluated the test accuracy of single and double FIT sampling to detect colorectal cancer (CRC) and/or advanced adenomas in an asymptomatic colonoscopy-controlled high-risk population. METHODS Cohort study of asymptomatic high-risk patients (personal history of adenomas/CRC or family history of CRC), who provided one or two FITs before elective colonoscopy. Test accuracy of FIT for detection of CRC and advanced adenomas was determined (cut-off level 50 ng/ml). RESULTS 1,041 patients provided a FIT (516 personal history of adenomas, 172 personal history of CRC and 353 family history of CRC). Five CRCs (0.5%) and 101 advanced adenomas (9.7%) were detected by colonoscopy. Single FIT sampling resulted in a sensitivity, specificity, PPV and NPV for CRC of 80%, 89%, 3% and 99.9%, respectively, and for advanced adenoma of 28%, 91%, 24% and 92%, respectively. Double FIT sampling did not result in a significantly higher sensitivity for advanced neoplasia. Simulation of multiple screening rounds indicated that sensitivity of FIT for advanced adenoma could reach 81% after 5 screening rounds. CONCLUSIONS In once-only FIT sampling before surveillance colonoscopy, 70% of advanced neoplasia were missed. A simulation approach indicates that multiple screening rounds may be more promising in detecting advanced neoplasia and could potentially alleviate endoscopic burden.
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Affiliation(s)
- Jochim S Terhaar sive Droste
- Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Sietze T van Turenhout
- Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Frank A Oort
- Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Vincent A Steeman
- Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Usha Coblijn
- Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Lisette van der Eem
- Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Ruud Duijkers
- Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Anneke A Bouman
- Clinical Chemistry, VU University Medical Centre, Amsterdam, The Netherlands
| | - Gerrit A Meijer
- Pathology, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Pieter Scholten
- Gastroenterology and Hepatology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Ruud JLF Loffeld
- Internal Medicine, Zaans Medical Centre, Zaandam, The Netherlands
| | - Veerle MH Coupé
- Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Chris JJ Mulder
- Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
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Gimeno-García AZ, Quintero E, Nicolás-Pérez D, Hernández-Guerra M, Parra-Blanco A, Jiménez-Sosa A. Screening for familial colorectal cancer with a sensitive immunochemical fecal occult blood test: a pilot study. Eur J Gastroenterol Hepatol 2009; 21:1062-7. [PMID: 19307978 DOI: 10.1097/meg.0b013e3283293797] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Colonoscopy is empirically recommended as the first choice screening strategy in first-degree relatives of patients with colorectal cancer (CRC). However, this strategy is accepted by less than 40% of the risk population and two-thirds of screened individuals and renders a normal exploration. This pilot study assessed the accuracy of a latex agglutination immunochemical fecal occult blood test (LA-FOBT) for detecting advanced colorectal neoplasm (cancer or adenomatous polyps > or =1 cm in size, with villous pattern or high grade dysplasia) in asymptomatic first-degree relatives of patients with CRC. METHODS One hundred and sixty-nine first-degree relatives of 135 index cases were prospectively included. All participants received a sensitive LA-FOBT (hemoglobin detection limit of 50 ng/ml buffer), and were invited to undergo colonoscopy. On the whole, 116 (69%) participants returned LA-FOBT and underwent colonoscopy. RESULTS LA-FOBT was positive in 19 of 116 (16%) cases. Colonoscopy detected neoplasms in 49 of 116 (42%) patients: 37 of 116 (32%) were nonadvanced adenomas and 12 of 116 (10%) advanced adenomas. LA-FOBT detected 10 of 12 (83%) advanced adenomas showing a sensitivity, specificity, positive predictive value, and negative predictive value of 83, 91, 53, and 98%, respectively. In patients with positive LA-FOBT, 1.9 colonoscopies were necessary for detecting one advanced adenoma, whereas in case of not performing this test 10 colonoscopies would be needed. Overall, approximately 80% of screening colonoscopies could be precluded using a LA-FOBT. CONCLUSION One-time screening with LA-FOBT successfully detects advanced colorectal adenomas and may save unnecessary colonoscopies in first-degree relatives of patients with CRC.
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Affiliation(s)
- Antonio Z Gimeno-García
- Department of Gastroenterology, University Hospital of Canary Islands, La Laguna, Tenerife, Spain
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Tytherleigh MG, Ng VV, Mathew LO, Banerjee T, Menon KV, Mee AS, Farouk R. Colonoscopy for screening and follow up of patients with a family history of colorectal cancer. Colorectal Dis 2008; 10:506-11. [PMID: 18318755 DOI: 10.1111/j.1463-1318.2007.01441.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the minimum family history of colorectal cancer (CRC), which justifies colonoscopy and to establish whether further colonic assessment is necessary after a negative screening colonoscopy. METHOD A retrospective review of every colonoscopy undertaken for family screening at the Royal Berkshire and Battle Hospitals, Reading between October 1996 and July 2004. RESULTS Four hundred and thirty-two patients (261 women) with an average age of 48 years (range 14-84) were screened. Three cancers in patients over the age of 60 years and 49 adenomas were found in 37 patients. Twenty three of 281 (8%) patients with a 'low-risk' family history (one in 12 or less lifetime risk of developing CRC) had either a cancer or an adenoma. Eighteen of 151 (12%) patients with a 'high-risk' family history (one in 10 or greater) had a similar positive colonoscopy. Thirteen of 15 patients who had an adenoma aged under 45 years had a high-risk family history. Seventy-three patients subsequently underwent two or more follow-up colonoscopies. There were 22 adenomatous polyps found in 12 patients (16%) at the first screening, nine adenomas in seven patients in the second colonoscopy and four adenomas found in four patients in all subsequent colonoscopies. CONCLUSION Patients with a low-risk family history have a similar adenoma pick-up to that of the general population. These patients need not be screened below the age of 50 unless symptomatic. Follow up of low-risk family history (FH) patients with a negative screening colonoscopy is unlikely to be beneficial.
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Abstract
There is now good evidence from case control studies and randomized controlled trials that screening average-risk subjects for colorectal cancer using faecal occult blood tests reduces mortality. There is limited data indicating that screening sigmoidoscopy can also achieve this. There is no evidence yet that screening by colonoscopy or double contrast barium enema can reduce mortality. Calculations of cost-effectiveness suggest that all of the above strategies should be economically worthwhile but there is no convincing evidence to suggest that one strategy is markedly more cost-effective than the others. Further data on several aspects of screening are required before any decisions are made on which form(s) of screening should be offered nationwide.
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Affiliation(s)
- D J Frommer
- Department of Medicine, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
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