Fecal immunochemical tests in combination with blood tests for colorectal cancer and advanced adenoma detection—systematic review

Niedermaier, Tobias; Weigl, Korbinian; Hoffmeister, Michael; Brenner, Hermann

doi:10.1177/2050640617737004

Cited by 17 publications

(14 citation statements)

References 34 publications

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“…FIT has already been recommended by NICE DG30 to triage patients with low-risk symptoms 2 for investigation, but at the time was not been recommended for high-risk symptoms, due to a lack of robust evidence within the UK setting and because f-Hb are known to vary by age, [11][12][13] sex, [11][12][13] deprivation, 13 14 cancer stage, 33 IDA 19 27 and between homogeneous ethnic populations. 15 We investigated these known covariates and found that there was no significant difference in FIT sensitivity for CRC across all groups including cancer stage and IDA at cut-offs of 2 and 10 µg/g.…”

Section: Gi Cancermentioning

confidence: 99%

Faecal immunochemical test is superior to symptoms in predicting pathology in patients with suspected colorectal cancer symptoms referred on a 2WW pathway: a diagnostic accuracy study

D’Souza

Delisle

Chen³

et al. 2020

Gut

129

148

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ObjectiveTo assess whether a faecal immunochemical test (FIT) could be used to select patients with suspected colorectal cancer (CRC) symptoms for urgent investigation.DesignMulticentre, double-blinded diagnostic accuracy study in 50 National Health Service (NHS) hospitals across England between October 2017 and December 2019. Patients referred to secondary care with suspected CRC symptoms meeting NHS England criteria for urgent 2 weeks wait referral and triaged to investigation with colonoscopy were invited to perform a quantitative FIT. The sensitivity of FIT for CRC, and effect of relevant variables on its diagnostic accuracy was assessed.Results9822 patients were included in the final analysis. The prevalence of CRC at colonoscopy was 3.3%. The FIT positivity decreased from 37.2% to 19.0% and 7.6%, respectively, at cut-offs of 2, 10 and 150 µg haemoglobin/g faeces (µg/g). The positive predictive values of FIT for CRC at these cut-offs were 8.7% (95% CI, 7.8% to 9.7%), 16.1% (95% CI 14.4% to 17.8%) and 31.1% (95% CI 27.8% to 34.6%), respectively, and the negative predictive values were 99.8% (95% CI 99.7% to 99.9%), 99.6% (95% CI 99.5% to 99.7%) and 98.9% (95% CI 98.7% to 99.1%), respectively. The sensitivity of FIT for CRC decreased at the same cut-offs from 97.0% (95% CI 94.5% to 98.5%) to 90.9% (95% CI 87.2% to 93.8%) and 70.8% (95% CI 65.6% to 75.7%), respectively, while the specificity increased from 64.9% (95% CI 63.9% to 65.8%) to 83.5% (95% CI 82.8% to 84.3%) and 94.6% (95% CI 94.1% to 95.0%), respectively. The area under the receiver operating characteristic curve was 0.93 (95% CI 0.92 to 0.95).ConclusionFIT sensitivity is maximised to 97.0% at the lowest cut-off (2 µg/g); a negative FIT result at this cut-off can effectively rule out CRC and a positive FIT result is better than symptoms to select patients for urgent investigations.Trial registration numberISRCTN49676259.

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Section: Gi Cancermentioning

confidence: 99%

Faecal immunochemical test is superior to symptoms in predicting pathology in patients with suspected colorectal cancer symptoms referred on a 2WW pathway: a diagnostic accuracy study

D’Souza

Delisle

Chen³

et al. 2020

Gut

129

148

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“…Thus, blood CRC biomarkers remain very attractive and are under investigation, including several molecules from nucleic acids such as DNA and various types of RNA (messenger, mRNA; micro, miRNA; long non-coding, lncRNA) to proteins, from circulating tumor cells to microvesicles. There is also growing interest in biomarker combination, which could obtain a higher sensitivity than single biomarker-based tests [ 72 , 75 , 76 ].…”

Section: New Testsmentioning

confidence: 99%

“…However, mSEPT9 is not able to distinguish between CRC and polyps or adenomas and seems not affected by tumor localization, but may be affected by age or sex, suggesting that age- and sex-specific cut-offs are required to better optimize the screening and diagnostic procedures [ 75 , 102 , 104 ]. The combination of mSEPT9 with the FIT test seems to improve the sensitivity for CRC and AA detection obtaining 94 and 43%, respectively, but at the cost of losing the specificity [ 76 ].…”

Section: New Testsmentioning

confidence: 99%

The Roadmap of Colorectal Cancer Screening

Ferlizza

Solmi

Sgarzi

et al. 2021

Cancers

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Colorectal cancer (CRC) is the third most common form of cancer in terms of incidence and the second in terms of mortality worldwide. CRC develops over several years, thus highlighting the importance of early diagnosis. National screening programs based on fecal occult blood tests and subsequent colonoscopy have reduced the incidence and mortality, however improvements are needed since the participation rate remains low and the tests present a high number of false positive results. This review provides an overview of the CRC screening globally and the state of the art in approaches aimed at improving accuracy and participation in CRC screening, also considering the need for gender and age differentiation. New fecal tests and biomarkers such as DNA methylation, mutation or integrity, proteins and microRNAs are explored, including recent investigations into fecal microbiota. Liquid biopsy approaches, involving novel biomarkers and panels, such as circulating mRNA, micro- and long-non-coding RNA, DNA, proteins and extracellular vesicles are discussed. The approaches reported are based on quantitative PCR methods that could be easily applied to routine screening, or arrays and sequencing assays that should be better exploited to describe and identify candidate biomarkers in blood samples.

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“…Focus on FIT screening results and emerging results from blood-based biomarker studies indicate that FIT screening has some location- and T stage-associated limitation in detecting neoplastic lesions [ 20 ], while blood-based biomarkers may have location-independent limitations with the T1 lesions of CRC and some adenomas [ 37 ]. Future achievements for improving CRC screening may therefore consider combinations of FIT and blood-based biomarkers [ 39 ]. Specifically, it may be considered that the combination identifies additional subjects with neoplastic lesions in comparison with the separate FIT or blood-based screening test, respectively.…”

mentioning

confidence: 99%

Triage May Improve Selection to Colonoscopy and Reduce the Number of Unnecessary Colonoscopies

Petersen

Ferm

Kleif

et al. 2020

Cancers

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Implementation of population screening for colorectal cancer by direct colonoscopy or follow-up colonoscopy after a positive fecal blood test has challenged the overall capacity of bowel examinations. Certain countries are facing serious colonoscopy capacity constraints, which have led to waiting lists and long time latency of follow-up examinations. Various options for improvement are considered, including increased cut-off values of the fecal blood tests. Results from major clinical studies of blood-based, cancer-associated biomarkers have, however, led to focus on a Triage concept for improved selection to colonoscopy. The Triage test may include subject age, concentration of hemoglobin in a feces test and a combination of certain blood-based cancer-associated biomarkers. Recent results have indicated that Triage may reduce the requirements for colonoscopy by around 30%. Such results may be advantageous for the capacity, the healthcare budgets and in particular, the subjects, who do not need an unnecessary, unpleasant and risk-associated bowel examination.

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Fecal immunochemical tests in combination with blood tests for colorectal cancer and advanced adenoma detection—systematic review

Abstract: Combining FIT and blood tests might be a promising approach to enhance sensitivity of CRC screening, but comprehensive evaluation of promising marker combinations in screening populations is needed.

Cited by 17 publications

References 34 publications

Faecal immunochemical test is superior to symptoms in predicting pathology in patients with suspected colorectal cancer symptoms referred on a 2WW pathway: a diagnostic accuracy study

Faecal immunochemical test is superior to symptoms in predicting pathology in patients with suspected colorectal cancer symptoms referred on a 2WW pathway: a diagnostic accuracy study

The Roadmap of Colorectal Cancer Screening

Triage May Improve Selection to Colonoscopy and Reduce the Number of Unnecessary Colonoscopies

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