title: Identification of colorectal adenomas by a quantitative immunochemical faecal occult blood screening test depends on adenoma characteristics, development threshold used and number of tests performed.
abstract: BACKGROUND
  Faecal occult blood tests (FOBT) are faulted by low sensitivity for advanced adenomatous polyps (AAP). Quantified, immunochemical, haemoglobin (Hb)-specific immunochemical FOBT (I-FOBT) measurements are now used for colorectal screening.
  
  
  OBJECTIVE
  To correlate adenoma characteristics to amount of faecal Hb lost and to evaluate sensitivity and specificity for AAP by faecal Hb development threshold used and number of I-FOBTs collected.
  
  
  METHODS
  Three daily I-FOBTs were collected and analysed in 1221 patients scheduled for colonoscopy. Faecal Hb was analysed as ngHb/mL of buffer and the highest result related to colonoscopy findings.
  
  
  RESULTS
  In 1204 patients without cancer, colonoscopy identified adenomas in 294, 99 with AAPs. Adenoma patients had elevated faecal Hb increasing with advanced histology, size, pedunculated shape and multiplicity (P < 0.001 for all). At 50 ngHb/mL threshold, sensitivity and specificity for AAPs were 54.5% (95%CI 44.7, 64.7) and 88.1% (95%CI 86.2, 90.1) for three tests. At higher thresholds, sensitivity decreased, but was significantly higher with more samples collected. Conversely, specificity increased at higher thresholds, but decreased with more samples.
  
  
  CONCLUSIONS
  Faecal Hb loss from adenomas is significantly associated with size, number and advanced features. Sensitivity and specificity for AAPs are determined by test threshold chosen and number of samples collected; these determine the number of colonoscopies needed for positive tests.
authors.affiliation: Gastroenterology Department, Rabin Medical Center, Beilinson Hospital, Petach Tikva. prozen@012.net.il
authors.forename: P
authors.initials: P
authors.lastname: Rozen
authors.forename: Z
authors.initials: Z
authors.lastname: Levi
authors.forename: R
authors.initials: R
authors.lastname: Hazazi
authors.forename: A
authors.initials: A
authors.lastname: Waked
authors.forename: A
authors.initials: A
authors.lastname: Vilkin
authors.forename: E
authors.initials: E
authors.lastname: Maoz
authors.forename: S
authors.initials: S
authors.lastname: Birkenfeld
authors.forename: M
authors.initials: M
authors.lastname: Leshno
authors.forename: Y
authors.initials: Y
authors.lastname: Niv
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D018256:Adenomatous Polyps; D000368:Aged; D003111:Colonic Polyps / Q000737:chemistry / Q000175:diagnosis*; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000737:chemistry / Q000175:diagnosis*; D005243:Feces / Q000737:chemistry; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009780:Occult Blood; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
chemical_list: D006454:Hemoglobins