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Fecal Immunochemical Testing for Colorectal Cancer Screening

Summary and Comment |
March 11, 2014

Fecal Immunochemical Testing for Colorectal Cancer Screening

  1. Jamaluddin Moloo, MD, MPH

FIT might prove to be more cost-effective than stool guaiac testing in most settings.

  1. Jamaluddin Moloo, MD, MPH

Fecal immunochemical testing for hemoglobin is more specific than stool guaiac testing because fecal immunochemical tests (FITs) return positive results only when globins are present — FITs don't react with foods that have peroxidase activity and aren't positive in patients with upper gastrointestinal (UGI) bleeding, because globin from UGI bleeds is digested. These characteristics negate the need to alter patients' diets, and a single sample usually is sufficient. In this meta-analysis of 19 studies (evaluating 8 different FITs), researchers estimated the diagnostic accuracy of FIT for detecting colorectal cancer.

The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 0.79, 0.94, 13.10, and 0.23, respectively. Performance characteristics did not change significantly when one, two, or three stool samples were used. No single FIT performed significantly better than the others.

Comment

This meta-analysis confirms previous findings in which fecal immunochemical testing was reported to be highly accurate for detecting cancer (NEJM JW Gen Med Nov 20 2012). Given that only a single stool sample is needed and diet modification is not necessary, FIT might prove to be more cost-effective than stool guaiac testing in most settings. Researchers currently are comparing FIT and colonoscopy in a large randomized trial with a primary outcome of colorectal cancer mortality (the CONFIRM trial), but results will not be available for many years.

  • Disclosures for Jamaluddin Moloo, MD, MPH at time of publication Grant / research support NIH

Citation(s):

Reader Comments (2)

Carol Vassar, MD Physician, Internal Medicine, private practice

What stage were the cancers that were detected. That would be a helpful surrogate while waiting for the mortality statistics.

jane Other Healthcare Professional, Endocrinology

não vale à pena levar aos convênios para tornar rotina ?

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