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- Title
Cutoff value determines the performance of a semi-quantitative immunochemical faecal occult blood test in a colorectal cancer screening programme.
- Authors
van Rossum, L. G. M.; van Rijn, A. F.; Laheij, R. J. F.; van Oijen, M. G. H.; Fockens, P.; Jansen, J. B. M. J.; Verbeek, A. L. M.; Dekker, E.
- Abstract
<bold>Background: </bold>The cutoff of semi-quantitative immunochemical faecal occult blood tests (iFOBTs) influences colonoscopy referrals and detection rates. We studied the performance of an iFOBT (OC-Sensor) in colorectal cancer (CRC) screening at different cutoffs.<bold>Methods: </bold>Dutch screening participants, 50-75 years of age, with average CRC risk and an iFOBT value >or=50 ng ml(-1) were offered colonoscopy. The detection rate was the percentage of participants with CRC or advanced adenomas (>or=10 mm, >or=20% villous, high-grade dysplasia). The number needed to scope (NNTScope) was the number of colonoscopies to be carried out to find one person with CRC or advanced adenomas.<bold>Results: </bold>iFOBT values >or=50 ng ml(-1) were detected in 526 of 6157 participants (8.5%) and 428 (81%) underwent colonoscopy. The detection rate for advanced lesions (28 CRC and 161 with advanced adenomas) was 3.1% (95% confidence interval: 2.6-3.5%) and the NNTScope was 2.3. At 75 ng ml(-1), the detection rate was 2.7%, the NNTScope was 2.0 and the CRC miss rate compared with 50 ng ml(-1) was <5% (N=1). At 100 ng ml(-1), the detection rate was 2.4% and the NNTScope was <2. Compared with 50 ng ml(-1), up to 200 ng ml(-1) CRC miss rates remained at 16% (N=4).<bold>Conclusions: </bold>Cutoffs below the standard 100 ng ml(-1) resulted in not only higher detection rates of advanced lesions but also more colonoscopies. With sufficient capacity, 75 ng ml(-1) might be advised; if not, up to 200 ng ml(-1) CRC miss rates are acceptable compared with the decrease in performed colonoscopies.
- Subjects
COLON cancer diagnosis; COLONOSCOPY; BLOOD testing; EPIDEMIOLOGY; GASTROENTEROLOGISTS; DYSPLASIA; IMMUNOCHEMISTRY; RESEARCH; RESEARCH methodology; MEDICAL screening; MEDICAL cooperation; EVALUATION research; COLORECTAL cancer; COMPARATIVE studies; FECAL occult blood tests
- Publication
British Journal of Cancer, 2009, Vol 101, Issue 8, p1274
- ISSN
0007-0920
- Publication type
journal article
- DOI
10.1038/sj.bjc.6605326