Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, China.
J Dig Dis. 2013 Sep;14(9):474-83. doi: 10.1111/1751-2980.12077.
We aimed to evaluate the performance of fecal occult blood tests (FOBT) for the screening of colorectal cancer (CRC).
We selected participants from a medical center in Taiwan, China from November 2009 to June 2011. All participants underwent screening colonoscopy and were asked to provide their stool samples for qualitative immunochemical FOBT (qlFIT), quantitative immunochemical FOBT (qnFIT) and the guaiac-based FOBT(GT). The receiver operating characteristic curve was utilized to determine the optimal cut-off value of qnFIT. We measured the detection ability of the FOBT for colonic polypoid lesions.
In all, 699 participants were enrolled in this study. For qnFIT, we found increased levels of fecal hemoglobin in participants with polyps ≥10 mm (251.0 ng/mL), villous-containing adenomas (98.7 ng/mL) and advanced adenomas (187.9 ng/mL). The optimal cut-off value for qnFIT was 25 ng/mL for detecting advanced colorectal neoplasms (ACRN). All three FOBT had a similar but low estimate in detecting small and tubular adenomatous polyps. The qnFIT had a better detection ability for large adenomas (positive likelihood ratio [PLR], 5.6 vs 3.1 vs 0.3) and adenomas with villous-components (PLR 3.7 vs 3.3 vs 0.3) than qlFIT and GT. For the ACRN group, qnFIT also showed the best screening ability with a sensitivity of 56.8%, accuracy of 86.7% and PLR 5.0.
Both qnFIT and qlFIT perform better than GT in detecting advanced adenomas and CRC in the Taiwanese population.
评估粪便潜血试验（FOBT）在结直肠癌（CRC）筛查中的性能。
我们从中国台湾地区的一家医疗中心选择了参与者，他们参加了 2009 年 11 月至 2011 年 6 月的筛查结肠镜检查，并被要求提供粪便样本进行定性免疫化学 FOBT（qlFIT）、定量免疫化学 FOBT（qnFIT）和基于愈创木脂的 FOBT（GT）。利用受试者工作特征曲线来确定 qnFIT 的最佳截断值。我们测量了 FOBT 对结直肠息肉样病变的检测能力。
共有 699 名参与者参加了这项研究。对于 qnFIT，我们发现息肉≥10mm（251.0ng/mL）、含绒毛腺瘤（98.7ng/mL）和高级别腺瘤（187.9ng/mL）患者的粪便血红蛋白水平升高。qnFIT 检测高级结直肠肿瘤（ACRN）的最佳截断值为 25ng/mL。三种 FOBT 对检测小的和管状腺瘤性息肉的估计值均较低。qnFIT 对大腺瘤（阳性似然比 [PLR]，5.6 对 3.1 对 0.3）和绒毛成分腺瘤（PLR 3.7 对 3.3 对 0.3）的检测能力优于 qlFIT 和 GT。对于 ACRN 组，qnFIT 的灵敏度为 56.8%，准确性为 86.7%，PLR 为 5.0，表现出最佳的筛查能力。
在台湾人群中，qnFIT 和 qlFIT 均优于 GT 检测高级别腺瘤和 CRC。
