title: Diagnostic accuracy of a single qualitative immunochemical fecal occult blood test coupled with physical measurements.
abstract: BACKGROUND
  We aimed to improve the sensitivity of immunochemical fecal occult blood test (I-FOBT) to screen colorectal neoplasm among average-risk adults.
  
  
  METHODS
  This is a diagnostic cohort study. All health examination participants receiving a single qualitative I-FOBT and a screening colonoscopy from January 2010 to June 2011 were included. Stool specimens were collected for I-FOBT before colonoscopy. Using pathology as gold standard, significant colorectal neoplasm was defined as advanced adenoma or malignancy.
  
  
  RESULTS
  A total of 1 007 health examinees were identified. Fifty-five (5.5%) had borderline positive (+/-) I-FOBT, while 38 (3.8%) had positive I-FOBT. Twenty-four (2.4%) had advanced adenoma, and five (0.5%) had carcinoma. Using borderline positive I-FOBT as cutoff value, the sensitivity and specificity for significant colorectal neoplasm were 34.5% (95% confidence interval (CI) 19.9%-52.7%) and 91.5% (95% CI 89.6%-93.1%), respectively. If combined with advanced age, high blood pressure (BP), and abdominal obesity, a fulfillment of either two criteria further increased the sensitivity to 72.4% (95% CI 54.3%-85.3%) with a specificity of 68.8% (95% CI 65.8%-71.6%).
  
  
  CONCLUSIONS
  The sensitivity of a single qualitative I-FOBT for the detection of significant colorectal neoplasm can be increased by coupling with age, BP, and abdominal obesity.
authors.affiliation: Department of Family Medicine, Renai Branch, Taipei City Hospital, Taipei, Taiwan, China; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, China.
authors.forename: Taiyin
authors.initials: T
authors.lastname: Wu
authors.affiliation: Department of Family Medicine, Renai Branch, Taipei City Hospital, Taipei, Taiwan, China.
authors.forename: Kuanliang
authors.initials: K
authors.lastname: Kuo
authors.affiliation: Department of Family Medicine, Renai Branch, Taipei City Hospital, Taipei, Taiwan, China; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, China.
authors.forename: Yifan
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Family Medicine, Renai Branch, Taipei City Hospital, Taipei, Taiwan, China.
authors.forename: Kuangyang
authors.initials: K
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009780:Occult Blood; D012680:Sensitivity and Specificity; D055815:Young Adult