Immunologische Stuhlbluttests – welche Verbesserungen gegenüber dem guajakbasierten Test?

Fecal immunochemical tests—what are the advantages compared to the guaiac-based fecal occult blood test?

Zusammenfassung

Hintergrund

Im gesetzlichen Krebsfrüherkennungsprogramm in Deutschland wurde im Jahr 2017 der herkömmliche guajakbasierte Test auf Blut im Stuhl („guaiac-based fecal occult blood test“, gFOBT) durch neuere immunologische Stuhlbluttests („fecal immunochemical tests“, FITs) ersetzt.

Ziel

In dieser Arbeit soll ein Überblick über die Vorteile der FITs gegenüber dem gFOBT gegeben werden.

Material und Methoden

Der Überblick basiert auf einer Zusammenfassung der wichtigsten Ergebnisse der internationalen Literatur.

Ergebnisse

FITs haben gegenüber dem gFOBT eine deutlich höhere Sensitivität für die Entdeckung von Darmkrebs und seinen Vorstufen. Sie weisen spezifisch menschliches Hämoglobin nach, ihre Anwendung ist daher nicht an die Einhaltung spezifischer Diätvorschriften gebunden. Zur Durchführung genügt eine einzelne Stuhlprobe aus einem einzelnen Stuhlgang. Die größere Nutzerfreundlichkeit erhöht die Akzeptanz.

Diskussion

Auf der Basis der vorliegenden Evidenz werden FITs zwischenzeitlich neben der Koloskopie als Mittel der Wahl eines nichtinvasiven Tests in der Darmkrebsvorsorge und -früherkennung empfohlen.

Abstract

Background

In 2017, the guaiac-based fecal occult blood test (gFOBT) which had been offered for colorectal cancer (CRC) screening since 1977 was replaced by fecal immunochemical tests (FITs) for hemoglobin in the German healthcare system.

Objectives

This article aims to summarize evidence on the advantages of FITs over gFOBT in CRC screening.

Materials and methods

Results of key studies from the international literature are summarized.

Results

FITs have higher sensitivity to detect CRC and its precursors than gFOBT. They specifically detect human hemoglobin in stool. Therefore, they are not influenced by dietary factors and do not require dietary restrictions. Only a single fecal sample from one single bowel movement is required. User-friendly application is accompanied by higher adherence rates.

Conclusions

Based on accumulating evidence, FITs are meanwhile widely recommended, besides screening colonoscopy, as the preferred noninvasive method for CRC screening.

This is a preview of subscription content, log in to check access.

Abb. 1

Literatur

  1. 1.

    Barzi A, Lenz HJ, Quinn DI et al (2017) Comparative effectiveness of screening strategies for colorectal cancer. Cancer 123:1516–1527

    Article  Google Scholar 

  2. 2.

    Brenner H, Tao S (2013) Superior diagnostic performance of faecal immunochemical tests for haemoglobin in a head-to-head comparison with guaiac based faecal occult blood test among 2235 participants of screening colonoscopy. Eur J Cancer 49:3049–3054

    CAS  Article  Google Scholar 

  3. 3.

    Brenner H, Werner S (2017) Selecting a cut-off for colorectal cancer screening with a fecal Immunochemical test. Clin Transl Gastroenterol 8(8):e111

    CAS  Article  Google Scholar 

  4. 4.

    Dinh T, Ladabaum U, Alperin P et al (2013) Health benefits and cost-effectiveness of a hybrid screening strategy for colorectal cancer. Clin Gastroenterol Hepatol 11:1158–1166

    Article  Google Scholar 

  5. 5.

    Faivre J, Dancourt V, Denis B et al (2012) Comparison between a guaiac and three immunochemical faecal occult blood tests in screening for colorectal cancer. Eur J Cancer 48:2969–2976

    CAS  Article  Google Scholar 

  6. 6.

    Gies A, Bhardwaj M, Stock C, Schrotz-King P, Brenner H (2018) Quantitative fecal immunochemical tests for colorectal cancer screening. Int J Cancer 143:234–244

    CAS  Article  Google Scholar 

  7. 7.

    Gies A, Cuk K, Schrotz-King P, Brenner H (2018) Direct comparison of diagnostic performance of 9 quantitative fecal Immunochemical tests for colorectal cancer screening. Gastroenterology 154:93–104

    Article  Google Scholar 

  8. 8.

    Gies A, Cuk K, Schrotz-King P, Brenner H (2018) Direct comparison of ten quantitative fecal immunochemical tests for hemoglobin stability in colorectal cancer screening. Clin Transl Gastroenterol 9(7):168

    Article  Google Scholar 

  9. 9.

    Hewitson P, Glasziou P, Watson E, Towler B, Irwig L (2008) Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update. Am J Gastroenterol 103:1541–1549

    Article  Google Scholar 

  10. 10.

    Hoffmeister M, Holleczek B, Zwink N, Stock C, Stegmaier C, Brenner H (2017) Screening for bowel cancer: increasing participation via personal invitation. Dtsch Arztebl Int 114:87–93

    PubMed  PubMed Central  Google Scholar 

  11. 11.

    Hol L, van Leerdam ME, van Ballegooijen M, van Vuuren AJ, van Dekken H, Reijerink JC, van der Togt AC, Habbema JD, Kuipers EJ (2010) Screening for colorectal cancer: randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy. Gut 59:62–68

    CAS  Article  Google Scholar 

  12. 12.

    Hundt S, Haug U, Brenner H (2009) Comparative evaluation of immunochemical fecal occult blood tests for colorectal adenoma detection. Ann Intern Med 150:162–169

    Article  Google Scholar 

  13. 13.

    Lansdorp-Vogelaar I, Kuntz KM, Knudsen AB et al (2010) Stool DNA testing to screen for colorectal cancer in the medicare population: a cost-effectiveness analysis. Ann Intern Med 153:368–377

    Article  Google Scholar 

  14. 14.

    Lee JK, Liles EG, Bent S, Levin TR, Corley DA (2014) Accuracy of fecal immunochemical tests for colorectal cancer: systematic review and meta-analysis. Ann Intern Med 160:171

    Article  Google Scholar 

  15. 15.

    Park DI, Ryu S, Kim YH et al (2010) Comparison of guaiac-based and quantitative immunochemical fecal occult blood testing in a population at average risk undergoing colorectal cancer screening. Am J Gastroenterol 105:2017–2025

    Article  Google Scholar 

  16. 16.

    Scholefield JH, Moss SM, Mangham CM, Whynes DK, Hardcastle JD (2012) Nottingham trial of faecal occult blood testing for colorectal cancer: a 20-year follow-up. Gut 61:1036–1040

    CAS  Article  Google Scholar 

  17. 17.

    Schreuders EH, Ruco A, Rabeneck L, Schoen RE, Sung JJ, Young GP, Kuipers EJ (2015) Colorectal cancer screening: a global overview of existing programmes. Gut 64:1637–1649

    Article  Google Scholar 

  18. 18.

    Sharaf RN, Ladabaum U (2013) Comparative effectiveness and cost-effectiveness of screening colonoscopy vs. sigmoidoscopy and alternative strategies. Am J Gastroenterol 108:120–132

    Article  Google Scholar 

  19. 19.

    Shaukat A, Mongin SJ, Geisser MS et al (2013) Long-term mortality after screening for colorectal cancer. N Engl J Med 369:1106–1114

    CAS  Article  Google Scholar 

  20. 20.

    van der Vlugt M, Grobbee EJ, Bossuyt PM, Bongers E, Spijker W, Kuipers EJ, Lansdorp-Vogelaar I, Essink-Bot ML, Spaander MC, Dekker E (2017) Adherence to colorectal cancer screening: four rounds of faecal immunochemical test-based screening. Br J Cancer 116:44–49

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Prof. Dr. H. Brenner.

Ethics declarations

Interessenkonflikt

H. Brenner und A. Gies geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

J. F. Riemann, Ludwigshafen

S. Zeuzem, Frankfurt am Main

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Brenner, H., Gies, A. Immunologische Stuhlbluttests – welche Verbesserungen gegenüber dem guajakbasierten Test?. Gastroenterologe 14, 6–13 (2019). https://doi.org/10.1007/s11377-018-0290-5

Download citation

Schlüsselwörter

  • Darmkrebs
  • Sekundärprävention
  • Okkultes Blut
  • Screening
  • Immunologischer Test

Keywords

  • Colorectal cancer
  • Secondary prevention
  • Occult blood
  • Screening
  • Immunologic test