Kang Q, Li N, Su H, Yang L, He Y Q, Jia K M, Wang X, Jin P, Sheng J Q
Department of Gastroenterology, the Seventh Medical Center of PLA General Hospital, Beijing 100700, China.
Zhonghua Yi Xue Za Zhi. 2020 Mar 17;100(10):767-770. doi: 10.3760/cma.j.cn112137-20200117-00115.
To investigate the significance of quantitative fecal immunochemical test (FIT) for opportunistic screening of colorectal neoplasia, and to propose the most optimal thresholds to improve the screening level of early colorectal neoplasia. The opportunistic screening participants were recruited from the Department of Gastroenterology & GI Endoscopy Center of the Seventh Medical Center of PLA General Hospital, and stool sample was collected before colonoscopy and the quantitative FIT was analyzed by OC-MICRO analysator for each patient. We assessed test performance in detecting colorectal neoplasia (advanced adenoma and CRC)with different thresholds on sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). A total of 1 448 objects were enrolled in this study, including 714 male (49.3%)and 734 female (50.7%).All participants were classified according to the result of colonoscopy and pathology, and 242 cases of colorectal neoplasia were found, containing 157 advanced adnoma and 85 colorectal cancer. The FIT threshold increased from 50 μg/L to 200 μg/L, while the positivity rate dropped from 11.5% to 8.6% and the sensitivity in detecting colorectal neoplasia dropped from 47.9% to 38.8%. However, the specificity increased from 96.8% to 98.2% and the positive predictive value increased from 82.3% to 87.0%.The miss rate of colorectal cancer increased from 11.8% (10) to 17.6% (15) along with the increase in FIT thresholds, but the miss rate of 100 μg/L and 150 μg/L was the same as 12.9% (11). Quantitative FIT,which is simple and fast,with the threshold of 100 μg/L for opportunistic screening, has a high sensitivity and specificity for the diagnosis of colorectal neoplasia,and is an important index in screening and diagnosis of colorectal neoplasia.
探讨粪便免疫化学定量检测（FIT）在结直肠肿瘤机会性筛查中的意义，并提出最优化阈值以提高早期结直肠肿瘤的筛查水平。机会性筛查参与者来自中国人民解放军总医院第七医学中心消化内科及消化内镜中心，在结肠镜检查前收集粪便样本，每位患者均采用OC-MICRO分析仪分析定量FIT。我们评估了不同阈值下FIT检测结直肠肿瘤（高级别腺瘤和结直肠癌）的性能，包括灵敏度、特异度、阳性预测值（PPV）和阴性预测值（NPV）。本研究共纳入1448例对象，其中男性714例（49.3%），女性734例（50.7%）。所有参与者均根据结肠镜检查及病理结果进行分类，共发现242例结直肠肿瘤，其中包括157例高级别腺瘤和85例结直肠癌。FIT阈值从50μg/L升高至200μg/L时，阳性率从11.5%降至8.6%，检测结直肠肿瘤的灵敏度从47.9%降至38.8%。然而，特异度从96.8%升至98.2%，阳性预测值从82.
