Colonoscopy-controlled intra-individual comparisons to screen relevant neoplasia: faecal immunochemical test vs. guaiac-based faecal occult blood test.
BACKGROUND
Guaiac-based faecal occult blood tests (g-FOBTs) are most commonly used in colorectal cancer (CRC) screening programmes. Faecal immunochemical tests (FITs) are thought to be superior.


OBJECTIVE
To compare performance of a g-FOBT and a quantitative FIT for detection of CRCs and advanced adenomas in a colonoscopy-controlled population.


METHODS
We assessed sensitivity and specificity of both FIT (OC-sensor) and g-FOBT (Hemoccult-II) prior to patients' scheduled colonoscopies.


RESULTS
Of the 62 invasive cancers detected in 1821 individuals, g-FOBT was positive in 46 and FIT in 54 (74.2% vs. 87.1%, P = 0.02). Among 194 patients with advanced adenomas, g-FOBT was positive in 35 and FIT in 69 (18.0% vs. 35.6%, P < 0.001). Sensitivity for screen relevant tumours (197 advanced adenomas and 28 stage I or II cancers) was 23.0% for g-FOBT and 40.5% for FIT (P < 0.001). Specificity of g-FOBT compared to FIT for the detection of cancer was 95.7% vs. 91.0%, P < 0.001) and for advanced adenomas (97.4% vs. 94.2%, P < 0.001).


CONCLUSIONS
Faecal immunochemical test is more sensitive for CRC and advanced adenomas. Sensitivity of FIT for screen relevant tumours, early-stage cancers and advanced adenomas, is significantly higher. Specificity of g-FOBT is higher compared with FIT.
Oort
F A
FA
Department of Gastroenterology and Hepatology, VU University Medical Center, 1007 MB Amsterdam, The Netherlands. f.oort@vumc.nl
Terhaar Sive Droste
J S
JS
Van Der Hulst
R W M
RW
Van Heukelem
H A
HA
Loffeld
R J L F
RJ
Wesdorp
I C E
IC
Van Wanrooij
R L J
RL
De Baaij
L
L
Mutsaers
E R
ER
van der Reijt
S
S
Coupe
V M H
VM
Berkhof
J
J
Bouman
A A
AA
Meijer
G A
GA
Mulder
C J J
CJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000473:pathology*; D055088:Early Detection of Cancer / Q000379:methods*; D005243:Feces; D005260:Female; D006138:Guaiac; D006801:Humans; D007150:Immunohistochemistry; D007202:Indicators and Reagents; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009780:Occult Blood; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D055815:Young Adult
D007202:Indicators and Reagents; D006138:Guaiac