Hijos-Mallada Gonzalo, Saura Nuria, Lué Alberto, Velamazan Raúl, Nieto Rocío, Navarro Mercedes, Arechavaleta Samantha, Chueca Eduardo, Gomollon Fernando, Lanas Angel, Sostres Carlos
Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain.
Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain.
Cancers (Basel). 2023 Jan 24;15(3):721. doi: 10.3390/cancers15030721.
Most colonoscopies performed to evaluate gastrointestinal symptoms detect only non-relevant pathologies. We aimed to evaluate the diagnostic accuracy of a qualitative point-of-care (POC) test combining four biomarkers (haemoglobin, transferrin, calprotectin, and lactoferrin), a quantitative faecal immunochemical test (FIT) for haemoglobin, and a quantitative faecal calprotectin (FC) test in symptomatic patients prospectively recruited. Colorectal cancer (CRC), adenoma requiring surveillance, inflammatory bowel disease (IBD), microscopic colitis, and angiodysplasia were considered significant pathologies. A total of 571 patients were included. Significant pathology was diagnosed in 118 (20.7%), including 30 CRC cases (5.3%). The POC test yielded the highest negative predictive values: 94.8% for a significant pathology and 100% for CRC or IBD if the four markers turned negative (36.8% of the patients). Negative predictive values of FIT, FC, and its combination for diagnosis of a significant pathology were 88.4%, 87.6%, and 90.8%, respectively. Moreover, the positive predictive value using the POC test was 82.3% for significant pathology when all biomarkers tested positive (6% of the patients), with 70.6% of these patients diagnosed with CRC or IBD. The AUC of the POC test was 0.801 (95%CI 0.754-0.848) for the diagnosis of a significant pathology. Therefore, this POC faecal test allows the avoidance of unnecessary colonoscopies and prioritizes high risk symptomatic patients.
大多数为评估胃肠道症状而进行的结肠镜检查仅发现不相关的病变。我们旨在评估一种定性即时检验（POC）联合四种生物标志物（血红蛋白、转铁蛋白、钙卫蛋白和乳铁蛋白）、一种用于血红蛋白的定量粪便免疫化学检验（FIT）以及一种定量粪便钙卫蛋白（FC）检验在对前瞻性招募的有症状患者中的诊断准确性。结直肠癌（CRC）、需要监测的腺瘤、炎症性肠病（IBD）、显微镜下结肠炎和血管发育异常被视为重大病变。共纳入571例患者。118例（20.7%）被诊断为重大病变，包括30例CRC病例（5.3%）。POC检验产生了最高的阴性预测值：如果四种标志物均为阴性（36.8%的患者），重大病变的阴性预测值为94.8%，CRC或IBD的阴性预测值为100%。FIT、FC及其联合用于诊断重大病变的阴性预测值分别为88.4%、87.6%和90.8%。此外，当所有生物标志物检测均为阳性时（6%的患者），使用POC检验对重大病变的阳性预测值为82.3%，其中70.6%的患者被诊断为CRC或IBD。POC检验诊断重大病变的AUC为0.801（95%CI 0.754 - 0.848）。因此，这种POC粪便检验可避免不必要的结肠镜检查，并对高风险有症状患者进行优先排序。
