title: Application of quantitative estimates of fecal hemoglobin concentration for risk prediction of colorectal neoplasia.
abstract: OBJECTIVE
  To determine the role of the fecal immunochemical test (FIT), used to evaluate fecal hemoglobin concentration, in the prediction of histological grade and risk of colorectal tumors.
  
  
  METHODS
  We enrolled 17881 individuals who attended the two-step colorectal cancer screening program in a single hospital between January 2010 and October 2011. Colonoscopy was recommended to the participants with an FIT of ≥ 12 ngHb/mL buffer. We classified colorectal lesions as cancer (C), advanced adenoma (AA), adenoma (A), and others (O) by their colonoscopic and histological findings. Multiple linear regression analysis adjusted for age and gender was used to determine the association between the FIT results and colorectal tumor grade. The risk of adenomatous neoplasia was estimated by calculating the positive predictive values for different FIT concentrations.
  
  
  RESULTS
  The positive rate of the FIT was 10.9% (1948/17881). The attendance rate for colonoscopy was 63.1% (1229/1948). The number of false positive results was 23. Of these 1229 cases, the numbers of O, A, AA, and C were 759, 221, 201, and 48, respectively. Regression analysis revealed a positive association between histological grade and FIT concentration (β = 0.088, P < 0.01). A significant log-linear relationship was found between the concentration and positive predictive value of the FIT for predicting colorectal tumors (R(2) > 0.95, P < 0.001).
  
  
  CONCLUSIONS
  Higher FIT concentrations are associated with more advanced histological grades. Risk prediction for colorectal neoplasia based on individual FIT concentrations is significant and may help to improve the performance of screening programs.
authors.affiliation: Chao-Sheng Liao, Yu-Min Lin, Hung-Chuen Chang, Lee-Won Chong, Chun-Hao Chen, Kuo-Ching Yang, Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan.
authors.forename: Chao-Sheng
authors.initials: CS
authors.lastname: Liao
authors.affiliation: Chao-Sheng Liao, Yu-Min Lin, Hung-Chuen Chang, Lee-Won Chong, Chun-Hao Chen, Kuo-Ching Yang, Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan.
authors.forename: Yu-Min
authors.initials: YM
authors.lastname: Lin
authors.affiliation: Chao-Sheng Liao, Yu-Min Lin, Hung-Chuen Chang, Lee-Won Chong, Chun-Hao Chen, Kuo-Ching Yang, Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan.
authors.forename: Hung-Chuen
authors.initials: HC
authors.lastname: Chang
authors.affiliation: Chao-Sheng Liao, Yu-Min Lin, Hung-Chuen Chang, Lee-Won Chong, Chun-Hao Chen, Kuo-Ching Yang, Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan.
authors.forename: Yu-Hung
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Chao-Sheng Liao, Yu-Min Lin, Hung-Chuen Chang, Lee-Won Chong, Chun-Hao Chen, Kuo-Ching Yang, Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan.
authors.forename: Lee-Won
authors.initials: LW
authors.lastname: Chong
authors.affiliation: Chao-Sheng Liao, Yu-Min Lin, Hung-Chuen Chang, Lee-Won Chong, Chun-Hao Chen, Kuo-Ching Yang, Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan.
authors.forename: Chun-Hao
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Chao-Sheng Liao, Yu-Min Lin, Hung-Chuen Chang, Lee-Won Chong, Chun-Hao Chen, Kuo-Ching Yang, Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan.
authors.forename: Yueh-Shih
authors.initials: YS
authors.lastname: Lin
authors.affiliation: Chao-Sheng Liao, Yu-Min Lin, Hung-Chuen Chang, Lee-Won Chong, Chun-Hao Chen, Kuo-Ching Yang, Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan.
authors.forename: Kuo-Ching
authors.initials: KC
authors.lastname: Yang
authors.affiliation: Chao-Sheng Liao, Yu-Min Lin, Hung-Chuen Chang, Lee-Won Chong, Chun-Hao Chen, Kuo-Ching Yang, Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan.
authors.forename: Chia-Hui
authors.initials: CH
authors.lastname: Shih
mesh_terms: D000236:Adenoma / Q000097:blood* / Q000473:pathology; D014408:Biomarkers, Tumor / Q000032:analysis*; D001706:Biopsy; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000097:blood* / Q000473:pathology; D005189:False Positive Reactions; D005243:Feces / Q000737:chemistry*; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007150:Immunohistochemistry; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; D006454:Hemoglobins
keywords: Colorectal cancer; Fecal immunochemical test; Performance; Risk prediction; Screening