Diagnostic Performance of Fecal Immunochemical Test and Sigmoidoscopy for Advanced Right-Sided Colorectal Neoplasms
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Colorectal cancer screening effect on right-sided colorectal neoplasia is limited. We compared fecal immunochemical test and simulated sigmoidoscopy diagnostic accuracy for advanced right-sided neoplasia detection.
We analyzed 1,292 individuals with complete screening colonoscopy with a fecal immunochemical test determination before colonoscopy. Sigmoidoscopy and “hybrid strategy” (sigmoidoscopy or fecal hemoglobin concentration ≥20 µg hemoglobin/g) diagnostic yield were simulated according to UK Flexible Sigmoidoscopy, Screening for COlon REctum (SCORE), and Norwegian Colorectal Cancer Prevention (NORCCAP) trials criteria to complete colonic examination. We compared sensitivity and specificity of both strategies and of “hybrid strategy” for advanced right-sided neoplasia with McNemar test.
An advanced right-sided neoplasia was detected in 47 (3.6 %) subjects. A fecal hemoglobin concentration ≥20 µg hemoglobin/g was determined in 6.6 % of the subjects and 10.1, 12.7, and 23.5 % met UK, SCORE, and NORCCAP criteria, respectively. Fecal immunochemical test was statistically more specific than sigmoidoscopy strategies (93.8 %, UK 90.3 %, SCORE 87.7 %, NORCCAP 77.8 %; p < 0.001). In contrast, fecal immunochemical test sensitivity for advanced right-sided neoplasia (17 %) was not statistically different than UK (21.3 %; p = 0.7) or SCORE (23.4 %; p = 0.5), although it was inferior than NORCCAP strategy (42.5 %; p < 0.001). Adding fecal immunochemical test to sigmoidoscopy increased number of positives (8.5–25.7 %), sensitivity (10–30 %), and significantly reduced advanced right-sided neoplasia specificity (p < 0.001).
Fecal immunochemical test and sigmoidoscopy diagnostic yield for advanced right-sided neoplasia are low. Fecal immunochemical test is more specific than sigmoidoscopy but less sensitive than sigmoidoscopy according to NORCCAP criteria.
KeywordsColorectal neoplasm Fecal immunochemical test Sigmoidoscopy Colonoscopy Colorectal cancer screening
This study was supported by grants from the Conselleria de Sanidade of Xunta de Galicia (PS09/74), Academia Médico Quirúrgica of Ourense, Instituto de Salud Carlos III (PI08/90717), Obra Social de Kutxa, Diputación Foral de Gipuzkoa (DFG 07/5), Departamento de Sanidad del Gobierno Vasco, EITB-Maratoia (BIO 07/CA/19), and Acción Transversal contra el Cáncer del CIBERehd (2008). This work was also supported by Dirección Xeral de Innovación e Xestión da Saúde Pública, Conselleria de Sanidade, Xunta de Galicia. The study sponsors had no involvement in the collection, analysis, and interpretation of data, writing of the manuscript, or in the decision to submit the manuscript for publication.
Conflict of interest
The authors declare that they have no conflict of interest.
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