title: Improvements in colorectal cancer screening programmes - quantitative immunochemical faecal occult blood testing - how to set the cut-off for a particular population.
abstract: OBJECTIVE
  The aim of the study was to determine the optimum cut-off value of the quantitative immunochemical test (q-FIT) OC-Sensor for colorectal cancer and advanced adenomatous polyps in a particular population.
  
  
  METHODS
  815 patients were referred for colonoscopy and were offered two q-FIT examinations at two different colonoscopy centers. The patients were classified according to the colonoscopic findings. Test sensitivity, specificity, and accuracy were statistically evaluated using one test and two tests at the levels of 50, 75, 100, 125, and 150 ng/mL of faecal hemoglobin in those patients with advanced polyps and colorectal cancer. The optimum cut-off test level for clinically significant neoplasia was determined using one test.
  
  
  RESULTS
  The optimum cut-off value of q-FIT OC-Sensor for the detection of clinically significant neoplasia in our particular population was determined as 75 ng/mL using one test. This value provides an optimum proportion of 73% sensitivity (±95% CI 60.3% - 83.4%) and 90% specificity (±95% CI 86.8% - 92.8%), PPV and NPV were determined as 54.76% and 95.43% respectively.
  
  
  CONCLUSIONS
  The first step in the implementation of q-FIT test in the screening program in our country is to determine the optimum cut-off level for a population, and to estimate the number of tests performed with respect to the optimum cost effectiveness and economical climate. Using one test, the optimum level of q-FIT OC-Sensor® in the Czech Republic was determined as 75 ng/mL. This study could serve as a model for further studies in other countries, where screening does not yet exist.
authors: 4th Department of Internal Medicine, General Teaching Hospital, First Faculty of Medicine, Charles University Prague, Czech Republic. s.l.a.v.k.a@seznam.cz
authors: Jaroslava Tereza
authors: JT
authors: Kovarova
authors: Miroslav
authors: M
authors: Zavoral
authors: Tomas
authors: T
authors: Zima
authors: Ales
authors: A
authors: Zak
authors: Petr
authors: P
authors: Kocna
authors: Pavel
authors: P
authors: Kohout
authors: Jana
authors: J
authors: Granatova
authors: Zdislava
authors: Z
authors: Vanickova
authors: Jana
authors: J
authors: Vranova
authors: Stepan
authors: S
authors: Suchanek
authors: Zdenek
authors: Z
authors: Benes
authors: Martin Alexander
authors: MA
authors: Celko
authors: Ctibor
authors: C
authors: Povysil
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007159:Immunologic Tests; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D012372:ROC Curve; D012680:Sensitivity and Specificity