Performance of the immunochemical fecal occult blood test in predicting lesions in the lower gastrointestinal tract

Chiang, Tung‐Liang; Lee, Yi–Chia; Tu, Chia‐Hung; Chiu, Han–Mo; Wu, Ming–Shiang

doi:10.1503/cmaj.101248

Cited by 87 publications

(93 citation statements)

References 37 publications

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“…For false positivity limited literature is available. Chiang et al 6 conducted a prospective cohort study, in which asymptomatic people age 18 years and older underwent a FIT test. They identified reasons for false positivity and found an association between false positivity and antiplatelet drugs.…”

Section: Discussionmentioning

confidence: 99%

“…They identified reasons for false positivity and found an association between false positivity and antiplatelet drugs. 6 Morikawa et al 32 investigated FIT sensitivity in detecting small adenomas. They found that the false positive rate increased with age in men.…”

Section: Discussionmentioning

confidence: 99%

“…According to Chiang et al individuals using antiplatelet drugs have an increased risk of having a false positive FIT. 6 To strengthen the evidence base for developing CRC screening programs, we analyzed data from a population screening study where all participants completed a risk questionnaire, submitted a FIT and underwent a full colonoscopy.…”

mentioning

confidence: 99%

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Risk factors for false positive and for false negative test results in screening with fecal occult blood testing

Stegeman

Wijkerslooth

Stoop

et al. 2013

Intl Journal of Cancer

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Differences in the risk of a false negative or a false positive fecal immunochemical test (FIT) across subgroups may affect optimal screening strategies. We evaluate whether subgroups are at increased risk of a false positive or a false negative FIT result, whether such variability in risk is related to differences in FIT sensitivity and specificity or to differences in prior CRC risk. Randomly selected, asymptomatic individuals were invited to undergo colonoscopy. Participants were asked to undergo one sample FIT and to complete a risk questionnaire. We identified patient characteristics associated with a false negative and false positive FIT results using logistic regression. We focused on statistically significant differences as well as on variables influencing the false positive or negative risk for which the odds ratio exceeded 1.25. Of the 1,426 screening participants, 1,112 (78%) completed FIT and the questionnaire; 101 (9.1%) had advanced neoplasia. 102 Individuals were FIT positive, 65 (64%) had a false negative FIT result and 66 (65%) a false positive FIT result. Participants at higher age and smokers had a significantly higher risk of a false negative FIT result. Males were at increased risk of a false positive result, so were smokers and regular NSAID users. FIT sensitivity was lower in females. Specificity was lower for males, smokers and regular NSAID users. FIT sensitivity was lower in women. FIT specificity was lower in males, smokers and regular NSAID users. Our results can be used for further evidence based individualization of screening strategies.Colorectal cancer (CRC) is one of the leading causes of cancer related death. 1 Detecting cancer or one of its precursors at an early stage can prevent premature death and may reduce cancer morbidity, since treatment for earlier-stage cancers is less aggressive than that for more advanced stage cancers. 2 The high incidence of CRC, the high burden of disease, the availability of screening tests and of effective treatment of adenomas make CRC a likely candidate for population screening.Colonoscopy is the reference standard for the detection of advanced adenoma and cancer in CRC screening. As it is a burdensome and costly procedure, fecal immunochemical test (FIT) is often used as a noninvasive triaging test for colonoscopy in CRC screening programs. Given its considerable false negative rate in the detection of advanced neoplasia, FIT should be applied at regular intervals for an optimal preventive effect. 3 With a specificity of 94% at the 50 ng/ml cut off, the accuracy of FIT based screening is suboptimal. 3 A

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Risk factors for false positive and for false negative test results in screening with fecal occult blood testing

Stegeman

Wijkerslooth

Stoop

et al. 2013

Intl Journal of Cancer

View full text Add to dashboard Cite

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“…They however claimed that the FOB test failed in detecting the GIS lesions. They attributed the false positive cases found in the course of study to the use of antiplatelet agents and the low hemoglobin concentration [8]. The study in question elaborated the diagnostic capabilities of the FOB test in general and under the elective conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Anorectal digital examination (DRE) should be performed both to investigate whether there is anorectal disease and to confirm the stool color described by the patient. Colonoscopy should be performed as soon as possible in patients presenting with acute lower GIS bleeding [8].…”

Section: Introductionmentioning

confidence: 99%

Retrospective investigation of the effectiveness of fecal occult blood test (FOB), PT-APTT in patients admitted to emergency department with gastrointestinal bleeding

Gürmen¹,

Avcil²,

Dağlı³

2017

Med-Science

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The purpose of our study is to investigate the fact that gastrointestinal system bleeding, which is a major cause of mortality, is not diagnosed faster by any additional laboratory tests except physical examination and endoscopy, but it is negative in terms of time, workload and cost. Our study was retrospective and the hospital information system was scanned and the patients who were referred to Emergency Medicine Clinic between 01.08.2012-08.08.2013 with Gastrointestinal System (GIS) bleeding symptoms and then underwent endoscopic examination were investigated. Demographic characteristics, physical examination findings, vital signs, required examinations, digital rectal examination findings, endoscopy and colonoscopy results were recorded in the study form. For statistical analysis, SPSS (Statistical Package for Social Sciences) 17.0 program was used. A total of 274 patients aged 18 years and over were admitted to the study and 61.7% were male and 38.3% were female. Most of the patients in our diagnostic group were in the 70-79 age group. Sensitivity of Digital Rectal Examination (DRE) value was 79.6% Specificity 92.30%, negative predictive value (NPV) 60%, Sensitivity of Fecal Occult Blood Test (FOB) value was 31.46% NPV 30.49%, sensitivity of international normalized ratio (INR) was 26.25% NPV 32,95%, sensitivity of prothrombin time (PT) was 19.37%, NPV 34.84%, sensitivity of activated partial thromboplastin time (aPTT) was 14.19% NPV 34.43%. Endoscopies were performed in 169 patients with GIS bleeding and no active bleeding detected in 56 (33.1%) patients and in 113 (66.9%) patients active bleeding was detected. In patients with positive digital rectal examination findings, endoscopy results were also highly positive for gastrointestinal system bleeding. Our study suggests that; Running FOB, PT, APTT, INR tests in patients admitted to emergency department with GIS bleeding, is far from giving important and necessary information about the emergency management of the patients to emergency medicine specialists. The results of the digital rectal examination correlate with endoscopy results. It is also an easy and time-consuming examination method. From this point of view, we would like to emphasize that making the DRE of all patients with suspected GIS bleeding is a correct and immediate approach to the emergency physician.

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Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial

et al. 2018

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Annual fecal immunochemical testing (FIT) is cost‐effective for colorectal cancer (CRC) screening. However, FIT positivity rates and positive predictive value (PPV) can vary substantially, with false‐positive (FP) results adding to colonoscopy burden without improving cancer detection. Our objective was to describe FIT PPV and the factors associated with FP results among patients undergoing CRC screening. In an ongoing pragmatic clinical trial of mailed‐FIT outreach, clinics delivered one of three FIT brands (InSure, OC‐Micro, and Hemosure). Patients who had a positive FIT result and a follow‐up colonoscopy were included in this analysis (N = 1130). Patients’ demographic and medical histories were abstracted from electronic health records (EHR). Associations with a FP result (ie, a positive FIT result with no evidence of advanced neoplasia during follow‐up colonoscopy) were evaluated for FIT brand and patient factors using mixed‐effects multivariable logistic regression. The mean proportion of FIT‐positive results ranged from 8% in centers using the OC‐Micro test to 21% for Hemosure. PPVs for advanced neoplasia were 0.30 to 0.17, respectively (P for χ 2 = 0.08). In multivariable‐adjusted models, use of Hemosure was associated with greater odds of a FP result than OC‐Micro (OR = 2.00, 95% CI: 0.47‐8.56) or InSure (OR = 1.72, 95% CI: 0.44‐6.68). However, only female sex (OR = 1.58, 95% CI: 1.19‐2.10) and history of a colorectal condition (OR = 2.17, 95% CI: 1.13‐4.15) were significantly associated with FP. In conclusion, FIT positivity varied by brand, and FP results differed by patient factors available through the EHR. These results can be used to minimize the frequency of FP results, reducing patient distress and colonoscopy burden.

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Performance of the immunochemical fecal occult blood test in predicting lesions in the lower gastrointestinal tract

Cited by 87 publications

References 37 publications

Risk factors for false positive and for false negative test results in screening with fecal occult blood testing

Risk factors for false positive and for false negative test results in screening with fecal occult blood testing

Retrospective investigation of the effectiveness of fecal occult blood test (FOB), PT-APTT in patients admitted to emergency department with gastrointestinal bleeding

Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial

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