title: Correlating Quantitative Fecal Immunochemical Test Results with Neoplastic Findings on Colonoscopy in a Population-Based Colorectal Cancer Screening Program: A Prospective Study.
abstract: Background and Aims. The Canadian Partnership Against Cancer (CPAC) recommends a fecal immunochemical test- (FIT-) positive predictive value (PPV) for all adenomas of ≥50%. We sought to assess FIT performance among average-risk participants of the British Columbia Colon Screening Program (BCCSP).Methods.From Nov-2013 to Dec-2014 consecutive participants of the BCCSP were assessed. Data was obtained from a prospectively collected database. A single quantitative FIT (NS-Plus, Alfresa Pharma Corporation, Japan) with a cut-off of ≥10μg/g (≥50 ng/mL) was used.Results. 20,322 FIT-positive participants underwent CSPY. At a FIT cut-off of ≥10μg/g (≥50 ng/mL) the PPV for all adenomas was 52.0%. Increasing the FIT cut-off to ≥20μg/g (≥100 ng/mL) would increase the PPV for colorectal cancer (CRC) by 1.5% and for high-risk adenomas (HRAs) by 6.5% at a cost of missing 13.6% of CRCs and 32.4% of HRAs.Conclusions.As the NS-Plus FIT cut-off rises, the PPV for CRC and HRAs increases but at the cost of missed lesions. A cut-off of ≥10μg/g (≥50 ng/mL) produces a PPV for all adenomas exceeding national recommendations. Health authorities need to take into consideration endoscopic resources when selecting a FIT positivity threshold.
authors.affiliation: St. Paul's Hospital, Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Neal
authors.identifier: 0000-0002-4536-0515
authors.initials: N
authors.lastname: Shahidi
authors.affiliation: British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Laura
authors.identifier: 0000-0001-5392-0650
authors.initials: L
authors.lastname: Gentile
authors.affiliation: British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Lovedeep
authors.identifier: 0000-0002-1707-8141
authors.initials: L
authors.lastname: Gondara
authors.affiliation: British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Jeremy
authors.identifier: 0000-0002-0700-8641
authors.initials: J
authors.lastname: Hamm
authors.affiliation: British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Colleen E
authors.initials: CE
authors.lastname: McGahan
authors.affiliation: St. Paul's Hospital, Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Robert
authors.identifier: 0000-0002-9018-4522
authors.initials: R
authors.lastname: Enns
authors.affiliation: St. Paul's Hospital, Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Jennifer
authors.identifier: 0000-0002-6884-6147
authors.initials: J
authors.lastname: Telford
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D001955:British Columbia; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D016208:Databases, Factual; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data*; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results