Burch J A, Soares-Weiser K, St John D J B, Duffy S, Smith S, Kleijnen J, Westwood M
Centre for Reviews and Dissemination (CRD), University of York, York YO10 5DD, UK.
J Med Screen. 2007;14(3):132-7. doi: 10.1258/096914107782066220.
To determine the accuracy of guaiac and immunochemical faecal occult blood tests (FOBTs) for the detection of colorectal cancer in an average-risk screening population.
Fifteen electronic databases, the internet, key journals and reference lists of included studies were searched. We included diagnostic accuracy studies that compared guaiac or immunochemical FOBTs with any reference standard, for the detection of colorectal cancer in an average-risk adult population, with sufficient data to construct a 2 x 2 table.
Fifty-nine studies were included. Thirty-three evaluated guaiac FOBTs, 35 immunochemical FOBTs and one evaluated sequential FOBTs. Sensitivities for the detection of all neoplasms ranged from 6.2% (specificity 98.0%) to 83.3% (specificity 98.4%) for guaiac FOBTs, and 5.4% (specificity 98.5%) to 62.6% (specificity 94.3%) for immunochemical FOBTs. Specificity ranged from 65.0% (sensitivity 44.1%) to 99.0% (sensitivity 19.3%) for guaiac FOBTs, and 89.4% (sensitivity 30.3%) to 98.5% (sensitivity 5.4%) for immunochemical FOBTs. Diagnostic case-control studies generally reported higher sensitivities. Sensitivities were higher for the detection of CRC, and lower for adenomas, in both the diagnostic cohort and diagnostic case-control studies for both guaiac and immunochemical FOBTs.
Immudia HemSp appeared to be the most accurate immunochemical FOBT, however, there was no clear evidence to suggest whether guaiac or immunochemical FOBTs performed better, either from direct or indirect comparisons. Poor reporting of data limited the scope of this review, and the use the Standards for Reporting of Diagnostic Accuracy guidelines is recommended for reporting future diagnostic accuracy studies.
确定愈创木脂法和免疫化学粪便潜血试验（FOBTs）在平均风险筛查人群中检测结直肠癌的准确性。
检索了15个电子数据库、互联网、主要期刊以及纳入研究的参考文献列表。我们纳入了诊断准确性研究，这些研究比较了愈创木脂法或免疫化学FOBTs与任何参考标准，用于在平均风险成年人群中检测结直肠癌，且有足够的数据来构建2×2列联表。
纳入了59项研究。33项评估了愈创木脂法FOBTs，35项评估了免疫化学FOBTs，1项评估了序贯FOBTs。愈创木脂法FOBTs检测所有肿瘤的敏感性范围为6.2%（特异性98.0%）至83.3%（特异性98.4%），免疫化学FOBTs的敏感性范围为5.4%（特异性98.5%）至62.6%（特异性94.3%）。愈创木脂法FOBTs的特异性范围为65.0%（敏感性44.1%）至99.0%（敏感性19.3%），免疫化学FOBTs的特异性范围为89.4%（敏感性30.3%）至98.5%（敏感性5.4%）。诊断性病例对照研究通常报告的敏感性较高。在愈创木脂法和免疫化学FOBTs的诊断队列和诊断性病例对照研究中，检测结直肠癌的敏感性较高，而检测腺瘤的敏感性较低。
Immudia HemSp似乎是最准确的免疫化学FOBT，但无论是直接还是间接比较，都没有明确证据表明愈创木脂法或免疫化学FOBTs哪种表现更好。数据报告不佳限制了本综述的范围，建议在报告未来的诊断准确性研究时使用《诊断准确性报告标准》指南。
