Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Cancer Med. 2021 Mar;10(5):1872-1879. doi: 10.1002/cam4.3761. Epub 2021 Feb 3.
Colorectal cancer (CRC) screening programs using fecal immunochemical test (FIT) have to choose a cut-off value to decide which citizens to recall for colonoscopy. The evidence on the optimal cut-off value is sparse and based on studies with a low number of cancer cases.
This observational study used data from the Danish Colorectal Cancer Screening Database. Sensitivity and specificity were estimated for various cut-off values based on a large number of cancers. Traditionally optimal cut-off values are found by weighting sensitivity and specificity equally. As this might result in too many unnecessary colonoscopies we also provide optimal cut-off values for different weighting of sensitivity and specificity/number of needed colonoscopies to detect one cancer.
Weighting sensitivity and specificity equally gives an optimal cut-off value of 45 ng Hb/ml. This, however, means making 24 colonoscopies to detect one cancer. Weighting sensitivity lower and for example, aiming at making about 16 colonoscopies to detect one cancer, gives an optimal cut-off value of 125 ng Hb/ml.
The optimal cut-off value in an FIT population-based screening program is 45 ng Hb/ml, when as traditionally sensitivity and specificity are weighted equally. If, however, 24 colonoscopies needed to detect one cancer is too huge a burden on the health care system and the participants, 80, 125, 175, and 350 ng Hb/ml are optimal cut-off values when only 19/16/14/10 colonoscopies are accepted to find one cancer.
使用粪便免疫化学检测（FIT）的结直肠癌（CRC）筛查计划必须选择一个截止值来决定召回哪些公民进行结肠镜检查。关于最佳截止值的证据很少，并且基于癌症病例数量较少的研究。
本观察性研究使用了丹麦结直肠癌筛查数据库的数据。根据大量癌症病例，估计了各种截止值的敏感性和特异性。传统上，通过对敏感性和特异性进行同等加权来找到最佳截止值。由于这可能导致过多不必要的结肠镜检查，我们还提供了不同敏感性和特异性/需要进行结肠镜检查以检测一个癌症的数量加权的最佳截止值。
对敏感性和特异性进行同等加权得到的最佳截止值为 45ng Hb/ml。然而，这意味着要进行 24 次结肠镜检查才能检测到一个癌症。如果降低敏感性并例如，旨在进行约 16 次结肠镜检查以检测一个癌症，则最佳截止值为 125ng Hb/ml。
在基于 FIT 的人群筛查计划中，最佳截止值为 45ng Hb/ml，此时传统上敏感性和特异性加权相等。然而，如果进行 24 次结肠镜检查以检测一个癌症的负担对医疗保健系统和参与者来说太大，则当仅接受 19/16/14/10 次结肠镜检查来发现一个癌症时，80、125、175 和 350ng Hb/ml 是最佳截止值。
