Division of Gastroenterology, American University of Beirut Medical Center, P.O. Box 11-0236/16-B, Beirut, Lebanon.
Department of Family Medicine, American University of Beirut Medical Center, PO Box: 11-0236, Riad El Sol, 1107 2020 Beirut, Lebanon.
Arab J Gastroenterol. 2021 Jun;22(2):174-176. doi: 10.1016/j.ajg.2021.04.002. Epub 2021 May 5.
Fecal Immunochemical Test (FIT) is one of the leading modalities for colorectal cancer screening. Studies show that FIT is highly sensitive for the detection of colorectal cancer (CRC) but not similarly accurate for detection of pre-cancerous advanced adenomas (AA). We studied the performance metrics of FIT for the detection of CRC and AA in ahealth maintenance organization (HMO) cohort screening program.
Retrospective cohort study of asymptomatic persons of screening age belonging to a HMO. Endoscopy and pathology reports of those who tested positive were used to calculate the positive predictive value (PPV) of FIT, and characterize endoscopic findings on colonoscopy.
Between 1995 and 2017, 3000 persons had screening fecal occult testing as part of their Employee Health Care plan. Of those, 150 had a positive qualitative FIT (cutoff 10 µg hemoglobin/g feces). All underwentcolonoscopy, and median time to colonoscopy was 27 days. 4 (2.6%) had carcinoma(2 stage IIIA and 2 stage IIIB), 106 (70.6%) had adenomas of which 40 (26.6% of the total cohort) had advanced adenomas (≥1 cm, villous features, or high-grade dysplasia) giving a PPV for AA and carcinoma of 29% and 3% respectively. When stratified by age, the PPV of AA; carcinoma was [50-59 (21.7%; 0.0%)], [60-69 (14.6%; 4.2%)], [70-79 (42.6%; 2.1%)], [80-89 (33.3%; 11.1%)].
The performance characteristics of FIT testing are acceptable for population screening in resource-limited settings. The resultsof this study are helpful when discussing expectations prior to colonoscopy in people with positive FIT.
粪便免疫化学检测（FIT）是结直肠癌筛查的主要方法之一。研究表明，FIT 对结直肠癌（CRC）的检测具有很高的敏感性，但对癌前高级腺瘤（AA）的检测准确性则不相同。我们在一个医疗保健组织（HMO）的队列筛查计划中研究了 FIT 对 CRC 和 AA 的检测性能指标。
对属于 HMO 的无症状筛查人群进行回顾性队列研究。根据阳性 FIT 检测结果，利用内镜和病理报告计算 FIT 的阳性预测值（PPV），并描述结肠镜下的内镜发现。
1995 年至 2017 年期间，有 3000 人参加了员工健康保健计划中的粪便潜血检测筛查。其中，有 150 人定性 FIT 检测结果阳性（截值 10µg 血红蛋白/g 粪便）。所有患者均接受了结肠镜检查，平均结肠镜检查时间为 27 天。4 人（2.6%）患有癌（2 例为 IIIA 期，2 例为 IIIB 期），106 人（70.6%）患有腺瘤，其中 40 人（占总队列的 26.6%）患有高级腺瘤（≥1cm，绒毛状特征或高级别异型增生），AA 和癌的 PPV 分别为 29%和 3%。按年龄分层，AA 的 PPV；癌为 [50-59 岁（21.7%；0.0%）]、[60-69 岁（14.6%；4.2%）]、[70-79 岁（42.6%；2.1%）]、[80-89 岁（33.3%；11.1%）]。
在资源有限的环境中，FIT 检测的性能特征可用于人群筛查。本研究结果有助于在阳性 FIT 检测结果的人群进行结肠镜检查前讨论预期结果。
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