Zhou Ru-Chen, Wang Pei-Zhu, Li Yue-Yue, Zhang Yan, Ma Ming-Jun, Meng Fan-Yi, Liu Chao, Yang Xiao-Yun, Lv Ming, Zuo Xiu-Li, Li Yan-Qing
Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
Front Med (Lausanne). 2021 Oct 26;8:762560. doi: 10.3389/fmed.2021.762560. eCollection 2021.
The diagnostic efficiency of the quantitative fecal immunochemical test (qFIT) has large variations in colorectal cancer (CRC) screening. We aimed to explore whether the practical sample collection operant training could improve the diagnostic accuracy of the qFIT in CRC screening. Moderate-/high-risk individuals aged 50-75 years old were invited to participate in a prospective observational study between July 2020 and March 2021. Participants took a qFIT sample without fecal sample collection operant training in advance and then completed another qFIT sample after the operant training. The primary outcome was the sensitivity and specificity of the qFITs for CRC and advanced colorectal neoplasia (ACRN). The secondary outcome was the difference in the area under the curves (AUCs) and the concentrations of the fecal hemoglobin (Hb) between the qFIT without and after the operant training. Out of 913 patients, 81 (8.9%) patients had ACRN, including 25 (2.7%) patients with CRC. For CRC, the sensitivities of the qFIT without and after the operant training at 10 μg/g were 80.4 and 100.0%, respectively, and the specificities were 90.1 and 88.4%, respectively. For ACRN, the sensitivities were 49.4 and 69.1% and the specificities were 91.7 and 91.3%, respectively. The AUC of the qFIT after the operant training was significantly higher than that without the operant training for CRC ( = 0.027) and ACRN ( = 0.001). After the operant training, the concentration of the fecal Hb was significantly higher than that without the operant training ( = 0.009) for ACRN, but there was no significant difference for CRC ( = 0.367). Practical sample collection operant training improves the diagnostic accuracy of the qFIT, which increases the detection of the low concentrations of fecal Hb. Improving the quality of the sample collection could contribute to the diagnostic efficiency of the qFIT in CRC screening.
定量粪便免疫化学检测（qFIT）在结直肠癌（CRC）筛查中的诊断效率存在很大差异。我们旨在探讨实际的样本采集操作培训是否能提高qFIT在CRC筛查中的诊断准确性。邀请年龄在50 - 75岁的中/高风险个体参加2020年7月至2021年3月的一项前瞻性观察研究。参与者在未提前进行粪便样本采集操作培训的情况下采集一份qFIT样本，然后在操作培训后再完成另一份qFIT样本。主要结局是qFIT对CRC和进展期结直肠肿瘤（ACRN）的敏感性和特异性。次要结局是操作培训前后qFIT的曲线下面积（AUC）差异以及粪便血红蛋白（Hb）浓度差异。在913例患者中，81例（8.9%）患有ACRN，其中25例（2.7%）患有CRC。对于CRC，操作培训前和后qFIT在10μg/g时的敏感性分别为80.4%和100.0%，特异性分别为90.1%和88.4%。对于ACRN，敏感性分别为49.4%和69.1%，特异性分别为91.7%和91.3%。操作培训后qFIT的AUC在CRC（P = 0.027）和ACRN（P = 0.001）方面显著高于未进行操作培训时。对于ACRN，操作培训后粪便Hb浓度显著高于未进行操作培训时（P = 0.009），但对于CRC无显著差异（P = 0.367）。实际的样本采集操作培训提高了qFIT的诊断准确性，增加了低浓度粪便Hb的检测。提高样本采集质量有助于提高qFIT在CRC筛查中的诊断效率。
