Diagnostic accuracy of faecal occult blood tests used in screening for colorectal cancer: a systematic review

Abstract

Objective To determine the accuracy of guaiac and immunochemical faecal occult blood tests (FOBTs) for the detection of colorectal cancer in an average-risk screening population. Methods Fifteen electronic databases, the internet, key journals and reference lists of included studies were searched. We included diagnostic accuracy studies that compared guaiac or immunochemical FOBTs with any reference standard, for the detection of colorectal cancer in an average-risk adult population, with sufficient data to construct a 2 Â 2 table.Results Fifty-nine studies were included. Thirty-three evaluated guaiac FOBTs, 35 immunochemical FOBTs and one evaluated sequential FOBTs. Sensitivities for the detection of all neoplasms ranged from 6.2% (specificity 98.0%) to 83.3% (specificity 98.4%) for guaiac FOBTs, and 5.4% (specificity 98.5%) to 62.6% (specificity 94.3%) for immunochemical FOBTs. Specificity ranged from 65.0% (sensitivity 44.1%) to 99.0% (sensitivity 19.3%) for guaiac FOBTs, and 89.4% (sensitivity 30.3%) to 98.5% (sensitivity 5.4%) for immunochemical FOBTs. Diagnostic case-control studies generally reported higher sensitivities. Sensitivities were higher for the detection of CRC, and lower for adenomas, in both the diagnostic cohort and diagnostic case-control studies for both guaiac and immunochemical FOBTs. Conclusions Immudia HemSp appeared to be the most accurate immunochemical FOBT, however, there was no clear evidence to suggest whether guaiac or immunochemical FOBTs performed better, either from direct or indirect comparisons. Poor reporting of data limited the scope of this review, and the use the Standards for Reporting of Diagnostic Accuracy guidelines is recommended for reporting future diagnostic accuracy studies.

Comparison of Uptake of Colorectal Cancer Screening Based on Fecal Immunochemical Testing (FIT) in Males and Females: A Systematic Review and Meta-analysis

“…However, colorectal cancer can be prevented, or treated effectively if detected early, through screening (3). Evidence indicates efficacy of screening in reducing cancer mortality and, in some instances, incidence (4)(5)(6)(7)(8).…”

Effect of Verification Bias on the Sensitivity of Fecal Occult Blood Testing: a Meta-Analysis

“…Other review articles have also reported a wide range of sensitivities. [7][8][9][10][11] The lack of a precise estimate of sensitivity has resulted in confusion among clinicians when applying FOBT for colorectal cancer screening. One reason for the wide range of sensitivities may relate to verification bias (also known as work-up bias).…”

Neutrophil-to-Lymphocyte Ratio, Plateletto- Lymphocyte Ratio, and Red Blood Cell Distribution Width as New Biomarkers in Patients with Colorectal Cancer

“…Thus, before performing gFOBTs, patients should avoid the drugs mentioned above and should follow a proper diet. The sensitivity and specificity for gFOBTs is 25-38% and 74%, respectively (24). However, these tests are currently no longer considered important, and their routine use has been discontinued.…”