title: Cutoff value determines the performance of a semi-quantitative immunochemical faecal occult blood test in a colorectal cancer screening programme.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. l.vanrossum@mdl.umcn.nl
authors.forename: L G M
authors.initials: LG
authors.lastname: van Rossum
authors.forename: A F
authors.initials: AF
authors.lastname: van Rijn
authors.forename: R J F
authors.initials: RJ
authors.lastname: Laheij
authors.forename: M G H
authors.initials: MG
authors.lastname: van Oijen
authors.forename: P
authors.initials: P
authors.lastname: Fockens
authors.forename: J B M J
authors.initials: JB
authors.lastname: Jansen
authors.forename: A L M
authors.initials: AL
authors.lastname: Verbeek
authors.forename: E
authors.initials: E
authors.lastname: Dekker
mesh_terms: D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007120:Immunochemistry; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009780:Occult Blood