title: Serum matrix metalloproteinase 9 and colorectal neoplasia: a community-based evaluation of a potential diagnostic test.
abstract: BACKGROUND
  A blood test may be a more acceptable routine colorectal cancer (CRC) screening test than faecal occult blood test, flexible sigmoidoscopy or colonoscopy, and could be safer and cheaper. We evaluated the accuracy of a serum matrix metalloproteinase (MMP9) test for CRC in a non-presenting symptomatic population.
  
  
  METHODS
  A cohort, aged 50-69 with lower gastrointestinal symptoms, was identified by community-based survey. Accuracy of serum MMP9 was assessed by comparison with colonoscopy. Logistic regression identified predictors of neoplasia and receiver operating characteristic curve analyses determined the cutoff to maximise the sensitivity.
  
  
  RESULTS
  Data were available for 748 patients. Overall, 46 cases of neoplasia were identified. Univariate analysis demonstrated that demographic characteristics, behavioural factors, clinical symptoms and raised serum MMP9 concentration were all significantly associated with the presence of neoplasia. Our final logistic regression model had a sensitivity of 79% and specificity of 70%.
  
  
  CONCLUSIONS
  We demonstrated a significant association between serum MMP9 concentration and the presence of neoplasia. Serum MMP9 levels are raised in those with cancer and high-risk adenomas, although MMP9 estimation is likely to have the greatest predictive utility when used as part of a panel of biomarkers. Further work is required to identify biomarkers that are sufficiently accurate for implementing into routine practice.
authors.affiliation: Department of Primary Care Clinical Sciences, University of Birmingham, Edgbaston, UK. s.wilson@bham.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: Wilson
authors.forename: S
authors.initials: S
authors.lastname: Damery
authors.forename: D D
authors.initials: DD
authors.lastname: Stocken
authors.forename: G
authors.initials: G
authors.lastname: Dowswell
authors.forename: R
authors.initials: R
authors.lastname: Holder
authors.forename: S T
authors.initials: ST
authors.lastname: Ward
authors.forename: V
authors.initials: V
authors.lastname: Redman
authors.forename: M J
authors.initials: MJ
authors.lastname: Wakelam
authors.forename: J
authors.initials: J
authors.lastname: James
authors.forename: F D R
authors.initials: FD
authors.lastname: Hobbs
authors.forename: T
authors.initials: T
authors.lastname: Ismail
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000097:blood* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood*; D008875:Middle Aged; D012680:Sensitivity and Specificity
chemical_list: D020780:Matrix Metalloproteinase 9