Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
Aliment Pharmacol Ther. 2013 Oct;38(7):835-41. doi: 10.1111/apt.12446. Epub 2013 Aug 20.
The role of a faecal immunochemical test (FIT) in screening individuals with a positive family history of colorectal cancer (CRC) is not clear.
To assess the diagnostic accuracy of FIT using colonoscopy findings as the gold standard in identifying colorectal neoplasms.
We analysed data from 4539 asymptomatic subjects aged 50-70 years who had both colonoscopy and FIT (Hemosure; W.H.P.M., Inc, El Monte, CA, USA) at our bowel cancer screening centre between 2008 and 2012. A total of 572 subjects (12.6%) had a family history of CRC. Our primary outcome was the sensitivity of FIT in detecting advanced neoplasms and cancers in subjects with a family history of CRC. A family history of CRC was defined as any first-degree relative with a history of CRC.
Among 572 subjects with a family history of CRC, adenoma, advanced neoplasm and cancer were found at screening colonoscopy in 29.4%, 6.5% and 0.7% individuals, respectively. The sensitivity of FIT in detecting adenoma, advanced neoplasm and cancer was 9.5% [95% confidence interval (CI), 5.7-15.3], 35.1% (95% CI, 20.7-52.6) and 25.0% (95% CI, 1.3-78.1), respectively. Among FIT-negative subjects who have a family history of CRC, adenoma was found in 152 (29.6%), advanced neoplasm in 24 (4.7%) and cancer in 3 (0.6%) individuals.
Compared with colonoscopy, FIT is more likely to miss advanced neoplasms or cancers in individuals with a family history of CRC.
粪便免疫化学检测（FIT）在筛查结直肠癌（CRC）阳性家族史个体中的作用尚不清楚。
以结肠镜检查结果为金标准，评估 FIT 在识别结直肠肿瘤中的诊断准确性。
我们分析了 2008 年至 2012 年在我们的结直肠癌筛查中心进行结肠镜检查和 FIT（Hemosure；W.H.P.M.，Inc，El Monte，CA，美国）的 4539 名 50-70 岁无症状受试者的数据。共有 572 名受试者（12.6%）有 CRC 家族史。我们的主要结局是 FIT 在检测 CRC 家族史受试者中高级别肿瘤和癌症的敏感性。CRC 家族史定义为任何一级亲属有 CRC 病史。
在 572 名有 CRC 家族史的受试者中，筛查结肠镜检查发现腺瘤、高级别肿瘤和癌症的分别为 29.4%、6.5%和 0.7%。FIT 检测腺瘤、高级别肿瘤和癌症的敏感性分别为 9.5%（95%CI，5.7-15.3）、35.1%（95%CI，20.7-52.6）和 25.0%（95%CI，1.3-78.1）。在 FIT 阴性且有 CRC 家族史的受试者中，发现 152 例（29.6%）腺瘤、24 例（4.7%）高级别肿瘤和 3 例（0.6%）癌症。
与结肠镜检查相比，FIT 更有可能漏诊 CRC 家族史个体中的高级别肿瘤或癌症。
