Department of Anorectal Surgery, the Eighth Hospital, Wuhan 430030, Hubei Province, China.
World J Gastroenterol. 2012 Jun 7;18(21):2682-8. doi: 10.3748/wjg.v18.i21.2682.
To evaluate the sensitivity and specificity of transfesrrin dipstick test (Tf) in colorectal cancer (CRC) screening and precancerous lesions screening.
Eight hundreds and sixty-one individuals at high-risk for CRC were recruited. Six hundreds and eleven subsequently received the three fecal occult blood tests and colonoscopy with biopsy performed as needed. Fecal samples were obtained on the day before colonoscopy. Tf, immuno fecal occult blood test (IFOBT) and guaiac fecal occult blood test (g-FOBT) were performed simultaneously on the same stool. To minimize false-negative cases, all subjects with negative samples were asked to provide an additional stool specimen for a second test even a third test. If the results were all negative after testing three repeated samples, the subject was considered a true negative. The performance characteristics of Tf for detecting CRC and precancerous lesions were examined and compared to those of IFOBT and the combination of Tf, IFOBT and g-FOBT.
A total of six hundreds and eleven subjects met the study criteria including 25 with CRC and 60 with precancerous lesions. Sensitivity for detecting CRC was 92% for Tf and 96% for IFOBT, specificities of Tf and IFOBT were both 72.0% (95% CI: 68.2%-75.5%; χ² = 0.4, P > 0.05); positive likelihood ratios of those were 3.3 (95% CI: 2.8-3.9) and 3.4 (95% CI: 2.9-4.0), respectively. In precancerous lesions, sensitivities for Tf and IFOBT were 50% and 58%, respectively (χ² = 0.8, P > 0.05); specificities of Tf and IFOBT were 71.5% (95% CI: 67.6%-75.1%) and 72.2% (95% CI: 68.4%-75.8%); positive likelihood ratios of those were 1.8 (95% CI: 1.3-2.3) and 2.1 (95% CI: 1.6-2.7), respectively; compared to IFOBT, g-FOBT+ Tf+ IFOBT had a significantly higher positive rate for precancerous lesions (83% vs 58%, respectively; χ² = 9.1, P < 0.05). In patients with CRC and precancerous lesions, the sensitivities of Tf and IFOBT were 62% and 69% (χ² = 0.9, P > 0.05); specificities of those were 74.5% (95% CI: 70.6%-78.1%) and 75.5% (95% CI: 71.6%-79.0%); positive likelihood ratios of those were 2.5 (95% CI: 2.0-3.1) and 2.8 (95% CI: 2.3-3.5). Compared to IFOBT alone, combining g-FOBT, IFOBT and Tf led to significantly increased sensitivity for detecting CRC and cancerous lesions (69% vs 88%, respectively; χ² = 9.0, P < 0.05).
Tf dipstick test might be used as an additional tool for CRC and precancerous lesions screening in a high-risk cohort.
评估转铁蛋白试纸检测（Tf）在结直肠癌（CRC）筛查和癌前病变筛查中的灵敏度和特异性。
招募了 861 名 CRC 高危个体。其中 611 名随后接受了三次粪便潜血试验和必要时进行的结肠镜检查和活检。结肠镜检查前一天采集粪便样本。同时在同一份粪便上进行 Tf、免疫粪便潜血试验（IFOBT）和愈创木脂粪便潜血试验（g-FOBT）。为了尽量减少假阴性病例，所有阴性样本的受试者均被要求提供额外的粪便标本进行第二次检测甚至第三次检测。如果三次重复样本检测结果均为阴性，则认为该受试者为真阴性。检查了 Tf 检测 CRC 和癌前病变的性能特征，并与 IFOBT 以及 Tf、IFOBT 和 g-FOBT 的组合进行了比较。
共有 611 名符合研究标准的受试者包括 25 名 CRC 患者和 60 名癌前病变患者。Tf 检测 CRC 的灵敏度为 92%，IFOBT 的灵敏度为 96%，Tf 和 IFOBT 的特异性均为 72.0%（95%CI：68.2%-75.5%；χ² = 0.4，P > 0.05）；阳性似然比分别为 3.3（95%CI：2.8-3.9）和 3.4（95%CI：2.9-4.0）。在癌前病变中，Tf 和 IFOBT 的灵敏度分别为 50%和 58%（χ² = 0.8，P > 0.05）；Tf 和 IFOBT 的特异性分别为 71.5%（95%CI：67.6%-75.1%）和 72.2%（95%CI：68.4%-75.8%）；阳性似然比分别为 1.8（95%CI：1.3-2.3）和 2.1（95%CI：1.6-2.7）；与 IFOBT 相比，g-FOBT+Tf+IFOBT 对癌前病变的阳性率显著更高（83% vs 58%，分别；χ² = 9.1，P < 0.05）。在 CRC 和癌前病变患者中，Tf 和 IFOBT 的灵敏度分别为 62%和 69%（χ² = 0.9，P > 0.05）；Tf 和 IFOBT 的特异性分别为 74.5%（95%CI：70.6%-78.1%）和 75.5%（95%CI：71.6%-79.0%）；阳性似然比分别为 2.5（95%CI：2.0-3.1）和 2.8（95%CI：2.3-3.5）。与单独使用 IFOBT 相比，联合使用 g-FOBT、IFOBT 和 Tf 可显著提高检测 CRC 和癌前病变的灵敏度（69% vs 88%，分别；χ² = 9.0，P < 0.05）。
Tf 试纸检测可能是 CRC 高危人群结直肠癌和癌前病变筛查的一种附加工具。
