霍奇金淋巴瘤幸存者结直肠癌监测粪便检测的诊断准确性
Diagnostic Accuracy of Stool Tests for Colorectal Cancer Surveillance in Hodgkin Lymphoma Survivors.
作者信息
Ykema Berbel, Rigter Lisanne, Spaander Manon, Moons Leon, Bisseling Tanya, Aleman Berthe, de Boer Jan Paul, Lugtenburg Pieternella, Janus Cecile, Petersen Eefke, Roesink Judith, Raemaekers John, van der Maazen Richard, Lansdorp-Vogelaar Iris, Gini Andrea, Verbeek Wieke, Lemmens Margriet, Meijer Gerrit, van Leeuwen Flora, Snaebjornsson Petur, Carvalho Beatriz, van Leerdam Monique
机构信息
Department of Gastroenterology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands.
出版信息
J Clin Med. 2020 Jan 10;9(1):190. doi: 10.3390/jcm9010190.
BACKGROUND
Hodgkin lymphoma (HL) survivors have an increased colorectal cancer (CRC) risk. Diagnostic accuracy of quantitative fecal immunochemical testing (FIT, OC Sensor) and/or a multi-target stool DNA test (mt-sDNA, Cologuard) for advanced neoplasia (AN) was evaluated.
METHODS
101 HL survivors underwent a surveillance colonoscopy and were asked to perform two stool tests (FIT and mt-sDNA). Advanced adenoma (AA), advanced serrated lesion (ASL), and AN (AA, ASL, CRC) were evaluated. Sensitivity, specificity, and area under the curve (AUC) for AN were calculated for different FIT cut-offs and mt-sDNA with colonoscopy as reference.
RESULTS
FIT and mt-sDNA were analyzed in 73 (72%) and 82 (81%) participants, respectively. AN was detected in 19 (26%) and 22 (27%), respectively. AN sensitivities for FIT cut-off of 10 ug Hb/g feces (FIT10) and mt-sDNA were 37% (95% confidence interval (CI): 16-62) and 68% (95% CI: 45-86), with corresponding specificities of 91% (95% CI: 80-97) and 70% (95% CI: 57-86), respectively. AUC for FIT was 0.68 (95% CI: 0.54-0.82) and for mt-sDNA 0.76 (95% CI: 0.63-0.89).
CONCLUSIONS
In HL survivors, mt-sDNA showed highest sensitivity but with relatively low specificity for AN. Cost-effectiveness analyses is necessary to determine the optimal surveillance strategy.
背景
霍奇金淋巴瘤（HL）幸存者患结直肠癌（CRC）的风险增加。评估了定量粪便免疫化学检测（FIT，OC传感器）和/或多靶点粪便DNA检测（mt-sDNA，Cologuard）对晚期瘤变（AN）的诊断准确性。
方法
101例HL幸存者接受了监测结肠镜检查，并被要求进行两项粪便检测（FIT和mt-sDNA）。评估了高级别腺瘤（AA）、高级别锯齿状病变（ASL）和AN（AA、ASL、CRC）。以结肠镜检查为参考，计算了不同FIT临界值和mt-sDNA对AN的敏感性、特异性和曲线下面积（AUC）。
结果
分别对73名（72%）和82名（81%）参与者进行了FIT和mt-sDNA分析。分别在19名（26%）和22名（27%）参与者中检测到AN。粪便血红蛋白浓度为10μg/g粪便（FIT10）的FIT和mt-sDNA对AN的敏感性分别为37%（95%置信区间（CI）：16-62）和68%（95%CI：45-86），相应的特异性分别为91%（95%CI：80-97）和70%（95%CI：57-86）。FIT的AUC为0.68（95%CI：0.54-0.82），mt-sDNA的AUC为0.76（95%CI：0.63-0.89）。
结论
在HL幸存者中，mt-sDNA对AN显示出最高的敏感性，但特异性相对较低。需要进行成本效益分析以确定最佳监测策略。
Zotero 插件