Gastroenterology

Gastroenterology

Volume 129, Issue 2, August 2005, Pages 422-428
Gastroenterology

Clinical-alimentary tract
A Comparison of the Immunochemical Fecal Occult Blood Test and Total Colonoscopy in the Asymptomatic Population

https://doi.org/10.1053/j.gastro.2005.05.056Get rights and content

Background & Aims: The fecal occult blood test (FOBT) is recommended as a screening test for colorectal cancer, but there are few reliable studies on the accuracy of immunochemical FOBT. The aim of this study was to analyze the sensitivity of immunochemical FOBT and to compare the results with the findings from complete colonoscopy. Methods: Asymptomatic adults underwent 1-time immunochemical FOBT and total colonoscopy simultaneously. The prevalence and location of colorectal neoplasia were determined by colonoscopy. The results of immunochemical FOBT and the colonoscopic findings were compared. Results: Of 21,805 patients, immunochemical FOBT was positive in 1231 cases (5.6%). The sensitivity of 1-time immunochemical FOBT for detecting advanced neoplasia and invasive cancer was 27.1% and 65.8%, respectively. In addition, the sensitivity for invasive cancer according to Dukes’ stage showed 50.0% for Dukes’ stage A, 70.0% for Dukes’ stage B, and 78.3% for Dukes’ stages C or D. The sensitivity for detecting advanced neoplasia at the proximal colon was significantly lower than that detected in the distal colon (16.3% vs 30.7%, P = .00007). Conclusions: Although the screening of asymptomatic patients with immunochemical FOBT can identify patients with colorectal neoplasia to a certain extent, the sensitivity is relatively low and different according to the tumor location. Therefore, programmatic and repeated screening by immunochemical FOBT may be necessary to increase sensitivity for colorectal cancer detection.

Section snippets

Study Design

A committee at Kameda General Hospital approved this study protocol consisting of a retrospective analysis of an existing dataset from patients who participated in a comprehensive health examination program at Kameda General Hospital or Kameda Makuhari Clinic between April 1983 and March 2002. All patients completed a questionnaire designed to examine whether they had any symptoms and what kinds of symptoms they had. Patients were excluded if they reported symptoms of disease of the lower

Patients

Of the 22,666 participants enrolled in this study, a complete colonoscopy was performed in 22,259 patients (98.2%), and 407 patients were excluded because of an incomplete colonoscopy. There were no serious complications during or after the colonoscopy. Patients lacking sufficient information on the polypoid lesion (location, size, or pathologic findings) also were excluded (n = 454). In the end, we analyzed 21,805 patients, comprising 15,694 men and 6111 women, with a mean age of 48.2 ± 9.3

Discussion

We evaluated the sensitivity of Magstream 1000/Hem SP, a type of immunochemical FOBT, in asymptomatic participants who underwent a complete colonoscopy. Many studies have provided information on immunochemical FOBT sensitivity and specificity for the detection of CRC, in which the sensitivity ranged from 47.1% to 100%, and the specificity ranged from 88.2% to 97.1%. 4, 5, 19, 20, 21, 22, 23, 24, 25 In these studies, however, colonoscopy was performed only in FOBT-positive cases, 5, 6 or studies

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