Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.
Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
Clin Transl Gastroenterol. 2021 Mar;12(3):e00319. doi: 10.14309/ctg.0000000000000319.
Noninvasive colorectal cancer (CRC) screening methods with higher sensitivity for advanced colorectal neoplasia (ACN) than the fecal immunochemical test (FIT) alone are warranted. This study aimed to elucidate the diagnostic performance of a risk stratification score calculated using baseline individual characteristics and its combination with FIT for detecting ACN.
This cross-sectional analysis of data from a prospective cohort in Izu Oshima, Japan, included asymptomatic individuals age 40-79 years who underwent both 2-day quantitative FIT and screening colonoscopy. The 8-point risk score, calculated based on age, sex, CRC family history, body mass index, and smoking history, was assessed. Colonoscopy results were used as reference.
Overall, 1,191 individuals were included, and 112 had ACN. The sensitivity and specificity of the 1-/2-day FIT (cutoff: 50-200 ng Hb/mL) for ACN were 17.9%-33.9% (4.9%-22.0% for right-sided ACN) and 91.8%-97.6%, respectively. The risk score's c-statistic for ACN was 0.66, and combining the score (cutoff: 5 points) with 1-/2-day FIT (cutoff: 50-200 ng Hb/mL) yielded a sensitivity and specificity for ACN of 46.4%-56.3% (43.9%-48.8% for right-sided ACN) and 76.6%-80.8%, respectively. The specificity of the risk score and FIT combination for all adenomatous lesions was 82.4%-86.4%.
The 8-point risk score remarkably increased the sensitivity for ACN, particularly for right-sided ACN. Although the specificity decreased, it was still maintained at a relatively high level. The risk score and FIT combination has the potential to become a viable noninvasive CRC screening option.
需要有比粪便免疫化学测试（FIT）更高的敏感性来检测高级结直肠肿瘤（ACN）的非侵入性结直肠癌（CRC）筛查方法。本研究旨在阐明使用基线个体特征计算的风险分层评分及其与 FIT 联合检测 ACN 的诊断性能。
本研究为日本伊豆大岛前瞻性队列研究的横断面分析，纳入了年龄在 40-79 岁之间的无症状个体，他们都接受了 2 天定量 FIT 和筛查结肠镜检查。基于年龄、性别、CRC 家族史、体重指数和吸烟史计算了 8 分风险评分。以结肠镜检查结果为参考。
共纳入 1191 名个体，其中 112 人患有 ACN。1/2 天 FIT（截止值：50-200ng Hb/mL）检测 ACN 的敏感性和特异性分别为 17.9%-33.9%（右 ACN 为 4.9%-22.0%）和 91.8%-97.6%。风险评分对 ACN 的曲线下面积为 0.66，将评分（截止值：5 分）与 1/2 天 FIT（截止值：50-200ng Hb/mL）联合使用，检测 ACN 的敏感性和特异性分别为 46.4%-56.3%（右 ACN 为 43.9%-48.8%）和 76.6%-80.8%。风险评分和 FIT 联合检测所有腺瘤性病变的特异性为 82.4%-86.4%。
8 分风险评分显著提高了对 ACN 的敏感性，特别是对右 ACN 的敏感性。虽然特异性有所下降，但仍保持在相对较高的水平。风险评分和 FIT 联合应用具有成为一种可行的非侵入性 CRC 筛查方法的潜力。
