St. Paul's Hospital, Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
British Columbia Cancer Agency, Vancouver, BC, Canada.
Can J Gastroenterol Hepatol. 2016;2016:4650471. doi: 10.1155/2016/4650471. Epub 2016 Dec 26.
. The Canadian Partnership Against Cancer (CPAC) recommends a fecal immunochemical test- (FIT-) positive predictive value (PPV) for all adenomas of ≥50%. We sought to assess FIT performance among average-risk participants of the British Columbia Colon Screening Program (BCCSP). From Nov-2013 to Dec-2014 consecutive participants of the BCCSP were assessed. Data was obtained from a prospectively collected database. A single quantitative FIT (NS-Plus, Alfresa Pharma Corporation, Japan) with a cut-off of ≥10 g/g (≥50 ng/mL) was used. . 20,322 FIT-positive participants underwent CSPY. At a FIT cut-off of ≥10 g/g (≥50 ng/mL) the PPV for all adenomas was 52.0%. Increasing the FIT cut-off to ≥20 g/g (≥100 ng/mL) would increase the PPV for colorectal cancer (CRC) by 1.5% and for high-risk adenomas (HRAs) by 6.5% at a cost of missing 13.6% of CRCs and 32.4% of HRAs. As the NS-Plus FIT cut-off rises, the PPV for CRC and HRAs increases but at the cost of missed lesions. A cut-off of ≥10 g/g (≥50 ng/mL) produces a PPV for all adenomas exceeding national recommendations. Health authorities need to take into consideration endoscopic resources when selecting a FIT positivity threshold.
加拿大癌症伙伴关系（CPAC）建议所有腺瘤的粪便免疫化学试验（FIT）阳性预测值（PPV）≥50%。我们试图评估不列颠哥伦比亚省结肠筛查计划（BCCSP）的一般风险参与者的 FIT 表现。从 2013 年 11 月到 2014 年 12 月，连续评估了 BCCSP 的参与者。数据来自前瞻性收集的数据库。使用单一的定量 FIT（NS-Plus，Alfresa Pharma Corporation，日本），其截止值≥10g/g（≥50ng/mL）。20322 名 FIT 阳性参与者接受了 CSPY。在 FIT 截止值≥10g/g（≥50ng/mL）时，所有腺瘤的 PPV 为 52.0%。将 FIT 截止值提高到≥20g/g（≥100ng/mL）将使 CRC 的 PPV 增加 1.5%，HRAs 的 PPV 增加 6.5%，但代价是漏诊 13.6%的 CRC 和 32.4%的 HRAs。随着 NS-Plus FIT 截止值的升高，CRC 和 HRAs 的 PPV 增加，但代价是遗漏病变。截止值≥10g/g（≥50ng/mL）产生的所有腺瘤的 PPV 超过了国家建议。卫生当局在选择 FIT 阳性阈值时需要考虑内镜资源。
