Department of Pathology and Laboratory Medicine, St Vincent's University Hospital, Dublin and UCD School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
Int J Cancer. 2011 Jan 1;128(1):3-11. doi: 10.1002/ijc.25654.
Several randomized controlled trials have shown that population-based screening using faecal occult blood testing (FOBT) can reduce mortality from colorectal neoplasia. Based on this evidence, a number of countries have introduced screening for colorectal cancer (CRC) and high-risk adenoma and many others are considering its introduction. The aim of this article is to critically review the current status of faecal markers as population-based screening tests for these neoplasia. Most of the available faecal tests involve the measurement of either occult blood or a panel of DNA markers. Occult blood may be measured using either the guaiac faecal occult blood test (gFOBT) or a faecal immunochemical test (iFOBT). Although iFOBT may require a greater initial investment, they have several advantages over gFOBT, including greater analytical sensitivity and specificity. Their use results in improved clinical performance and higher uptake rates. Importantly for population screening, some of the iFOBTs can be automated and provide an adjustable cutoff for faecal haemoglobin concentration. However, samples for iFOBT, may be less stable after collection than for gFOBT. For new centres undertaking FOBT for colorectal neoplasia, the European Group on Tumour Markers recommends use of a quantitative iFOBT with an adjustable cutoff point and high throughput analysis. All participants with positive FOBT results should be offered colonoscopy. The panel recommends further research into increasing the stability of iFOBT and the development of improved and affordable DNA and proteomic-based tests, which reduce current false negative rates, simplify sample transport and enable automated analysis.
几项随机对照试验表明，基于人群的粪便潜血检测（FOBT）筛查可以降低结直肠肿瘤的死亡率。基于这一证据，许多国家已经开展了结直肠癌（CRC）和高危腺瘤的筛查，还有许多国家正在考虑开展这一筛查。本文旨在批判性地回顾粪便标志物作为这些肿瘤的人群筛查试验的现状。大多数现有的粪便检测都涉及对隐匿性血液或一组 DNA 标志物的测量。隐匿性血液可以使用愈创木脂粪便潜血检测（gFOBT）或粪便免疫化学检测（iFOBT）进行测量。虽然 iFOBT 可能需要更大的初始投资，但它们与 gFOBT 相比具有几个优势，包括更高的分析灵敏度和特异性。它们的使用可提高临床性能和更高的吸收率。对人群筛查来说重要的是，一些 iFOBT 可以自动化，并提供可调节的粪便血红蛋白浓度截断值。然而，与 gFOBT 相比，iFOBT 的样本在收集后可能不太稳定。对于新开展结直肠肿瘤 FOBT 的中心，欧洲肿瘤标志物专家组建议使用带有可调节截断值和高通量分析的定量 iFOBT。所有 FOBT 阳性结果的参与者都应接受结肠镜检查。专家组建议进一步研究提高 iFOBT 的稳定性，并开发改进和负担得起的基于 DNA 和蛋白质组的检测方法，以降低当前的假阴性率，简化样本运输并实现自动化分析。
