Abstract | BACKGROUND: Immunochemical tests show important advantages over chemical-based faecal occult blood tests (FOBT) for colorectal cancer (CRC) screening, but comparison studies are limited. This study was performed to compare the accuracy of a sensitive immunochemical test with the guaiac test for detecting significant neoplasia (advanced adenomas and CRC) in an average-risk population. METHODS: A random sample of 2288 asymptomatic subjects 50-79 years of age was prospectively included. Participants received three cards of the guaiac test, one sample of a latex-agglutination test (haemoglobin cut-off 50 ng/ml), and an invitation to undergo colonoscopy. Test sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated in 1756 compliers. RESULTS: Immunochemical and guaiac tests were positive in 143 (8.1%) and 62 (3.5%) subjects, respectively. Complete colonoscopy, performed in 402 participants (158 FOBT+ and 244 FOBT-), detected 14 (0.8%) patients with CRC and 49 (2.8%) with advanced adenomas. The immunochemical and guaiac tests for significant colorectal neoplasia showed sensitivities of 61% versus 23.8%, specificities of 95.1% versus 97.7%, PPVs of 43.4% versus 39.0%, and NPVs of 97.5% versus 95.4%, respectively. Proximal significant neoplasms were more frequently detected with the immunochemical test (85% vs. 15%) The relative risk for detecting significant neoplasia was superior in patients with a positive immunochemical test (RR 16.93; CI 7.94-36.10) than with a positive guaiac test (RR 3.34; CI 2.17-5.15). CONCLUSION: A sensitive immunochemical test is markedly superior to the guaiac test for detecting significant colorectal neoplasia, and should be considered the first-choice FOBT for CRC screening in the average-risk population.
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Authors | Adolfo Parra-Blanco, Antonio Z Gimeno-García, Enrique Quintero, David Nicolás, Santiago G Moreno, Alejandro Jiménez, Manuel Hernández-Guerra, Marta Carrillo-Palau, Yoshinobu Eishi, Julio López-Bastida |
Journal | Journal of gastroenterology
(J Gastroenterol)
Vol. 45
Issue 7
Pg. 703-12
(Jul 2010)
ISSN: 1435-5922 [Electronic] Japan |
PMID | 20157748
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
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Topics |
- Aged
- Colonoscopy
- Colorectal Neoplasms
(diagnosis)
- Female
- Guaiac
- Humans
- Immunologic Tests
(methods)
- Male
- Mass Screening
(methods)
- Middle Aged
- Occult Blood
- Predictive Value of Tests
- Prospective Studies
- Sensitivity and Specificity
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