Department of Oncology and Laboratory Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan.
Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan.
Clin Transl Gastroenterol. 2020 Jun;11(6):e00176. doi: 10.14309/ctg.0000000000000176.
We have reported previously that fecal DNA testing of TWIST1 methylation in combination with the fecal immunochemical test for hemoglobin (FIT) (combination test) is useful for colorectal neoplasia screening. In this study, using larger sample sizes, we studied the clinical performance of the combination test for the detection of colorectal neoplasia and, especially, advanced colorectal adenoma.
We performed a prospective study in which FIT, fecal DNA testing of TWIST1 methylation, and colonoscopy were performed on 372 patients with colorectal neoplasia and 71 subjects without colorectal neoplasia. We assessed the individual clinical performance of each of FIT and fecal DNA testing of TWIST1 methylation and of the combination test for the detection of colorectal neoplasia including advanced adenoma based on morphologic subtypes.
The FIT alone had a sensitivity of 7.5% (3/40) for nonadvanced adenoma, 32.3% (41/127) for advanced adenoma, and 93.7% (192/205) for colorectal cancer and a specificity of 87.3% (62/71). The combination test had a sensitivity of 35.0% (14/40) for nonadvanced adenoma, 68.5% (87/127) for advanced adenoma, and 95.6% (196/205) for colorectal cancer and a specificity of 80.3% (57/71). For morphological subtypes of advanced adenoma, the sensitivity of FIT was only 28.2% (20/71) for polypoid type and 16.1% (5/31) for nonpolypoid type, whereas the combination test increased the sensitivities to 64.8% (46/71) and 71.0% (22/31), respectively.
The combination of the fecal DNA test with FIT seemed to be useful to detect colorectal neoplasia and, especially, advanced adenoma of the nonpolypoid type.
我们之前曾报道过，TWIST1 甲基化粪便 DNA 检测联合粪便血红蛋白免疫化学检测（组合检测）对结直肠肿瘤筛查具有一定价值。在本研究中，我们使用更大的样本量，研究了组合检测对结直肠肿瘤，尤其是进展期结直肠腺瘤的临床检测性能。
我们进行了一项前瞻性研究，纳入了 372 例结直肠肿瘤患者和 71 例非结直肠肿瘤患者，所有患者均接受了 FIT、TWIST1 甲基化粪便 DNA 检测和结肠镜检查。我们根据形态学亚型评估了 FIT 和 TWIST1 甲基化粪便 DNA 检测以及组合检测对结直肠肿瘤（包括进展期腺瘤）的单独临床检测性能。
FIT 对非进展性腺瘤的敏感性为 7.5%（3/40），对进展性腺瘤为 32.3%（41/127），对结直肠癌为 93.7%（192/205），特异性为 87.3%（62/71）。组合检测对非进展性腺瘤的敏感性为 35.0%（14/40），对进展性腺瘤为 68.5%（87/127），对结直肠癌为 95.6%（196/205），特异性为 80.3%（57/71）。对于进展性腺瘤的形态学亚型，FIT 对息肉型的敏感性仅为 28.2%（20/71），对非息肉型的敏感性为 16.1%（5/31），而组合检测将敏感性分别提高至 64.8%（46/71）和 71.0%（22/31）。
粪便 DNA 检测与 FIT 的联合应用似乎有助于检测结直肠肿瘤，尤其是非息肉型进展性腺瘤。
