Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Coventry, UK.
Medical School, University of Warwick, Coventry, UK.
Aliment Pharmacol Ther. 2017 Jan;45(2):354-363. doi: 10.1111/apt.13865. Epub 2016 Dec 1.
The diagnosis of colorectal cancer (CRC) can be difficult as symptoms are variable with poor specificity. Thus, there is a quest for simple, non-invasive testing that can help streamline those with significant colonic pathology.
To assess using faecal immunochemical test for haemoglobin (FIT) or faecal calprotectin (FCP) to detect CRC and adenoma in symptomatic patients referred from primary care.
A total of 799 referred for urgent lower gastrointestinal investigations were prospectively recruited. Of these, 430 completed colonic investigations and returned stool samples, and were included in the final statistical analysis. Faecal immunochemical test for haemoglobin was performed on HM-JACKarc analyser (Kyowa Medex, Tokyo, Japan), and FCP by the EliA Calprotectin immunoassay (Thermo Fisher Scientific, Waltham, United States).
The negative predictive value (NPV) using FIT alone or both markers (FIT and FCP) in combination was similar at 99% for CRC, with a sensitivity and specificity of 84% and 93%, respectively. FIT measurements were significantly higher in left-sided colonic lesions compared with the right side; 713 vs. 94; P = 0.0203). For adenoma, the NPV using FIT alone, or both markers (FIT and FCP) in combination, was similar at 94% with a sensitivity and specificity of 69% and 56%, respectively.
Undetectable faecal immunochemical test for haemoglobin is sufficiently sensitive to exclude colorectal cancer, with higher values in left-sided lesions. FCP in combination does not appear to provide additional diagnostic information. Further studies to determine the health economic benefits of implementing faecal immunochemical test for haemoglobin in primary care are required.
结直肠癌（CRC）的诊断较为困难，因为其症状存在变异性且特异性较差。因此，人们一直在寻求简单、非侵入性的检测方法，以帮助对存在明显结肠病变的患者进行分类。
评估粪便免疫化学检测血红蛋白（FIT）或粪便钙卫蛋白（FCP）在初级保健转介的有症状患者中检测 CRC 和腺瘤的能力。
共前瞻性招募了 799 例因下消化道紧急情况而转介的患者。其中，430 例完成了结肠检查并返回粪便样本，最终纳入了统计分析。使用 HM-JACKarc 分析仪（日本京王医药株式会社）进行粪便免疫化学检测血红蛋白，使用 EliA Calprotectin 免疫测定法（美国赛默飞世尔科技公司）进行粪便钙卫蛋白检测。
FIT 单独或两种标志物（FIT 和 FCP）联合使用时，CRC 的阴性预测值（NPV）相似，均为 99%，敏感性和特异性分别为 84%和 93%。左半结肠病变的 FIT 检测值明显高于右半结肠；713 比 94；P = 0.0203）。对于腺瘤，FIT 单独或两种标志物（FIT 和 FCP）联合使用时，NPV 相似，均为 94%，敏感性和特异性分别为 69%和 56%。
无法检测到的粪便免疫化学检测血红蛋白对于排除 CRC 具有足够的敏感性，且左半结肠病变的 FIT 检测值更高。FCP 联合检测似乎并不能提供额外的诊断信息。需要进一步研究以确定在初级保健中实施粪便免疫化学检测血红蛋白的健康经济效益。
