Skip to main content
SpringerLink
Log in

Use of a Low Cut-Off Value for the Fecal Immunochemical Test Enables Better Detection of Proximal Neoplasia

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

The advantage of the quantitative fecal immunochemical test (FIT) is the flexibility to set the positivity threshold. However, the diagnostic success of the FIT has not been compared for standard and low cut-off thresholds.

Aims

The purpose of this study was to compare the diagnostic success of FIT for standard and low cut-off thresholds.

Methods

In 2009 and 2010 a standard cut-off threshold (20 μg Hb/g feces) was used as positivity criterion for the FIT; in 2012 a low cut-off (10 μg Hb/g feces) was used. Diagnostic success was compared between the two groups.

Results

Of the total of 14,289 participants, 195 (1.4 %) had positive FIT results. Positivity of the FIT was significantly higher in the low cut-off group than in the standard cut-off group (1.8 vs. 1.0 %, p = 0.000). Although detection of advanced neoplasia lesions was comparable, proximal neoplasia was more frequently detected in the low cut-off group (33.3 vs. 20.9 %, p = 0.016). With the low cut-off threshold, 39 (0.7 %) participants were also classified as having positive results, and 18 (46.2 %) of these had colorectal neoplasias. The number of positive results from the FIT was increased by 54.9 %, and detection of advanced neoplasia was increased by 60 % with the low cut-off threshold compared with the standard cut-off.

Conclusions

A low cut-off threshold for the FIT resulted in better detection of proximal neoplasia in population-based screening. These results indicate the cut-off threshold for positive FIT should be properly chosen and adjusted in colorectal cancer screening.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Choi KS, Jun JK, Lee HY, Hahm MI, Oh JH, Park EC. Increasing uptake of colorectal cancer screening in Korea: a population-based study. BMC Public Health.. 2010;10:265.

    Article  PubMed  Google Scholar 

  2. Shim JI, Kim Y, Han MA, et al. Results of colorectal cancer screening of the national cancer screening program in Korea, 2008. Cancer Res Treat.. 2010;42:191–198.

    Article  PubMed  Google Scholar 

  3. Winawer SJ, Flehinger BJ, Schottenfeld D, Miller DG. Screening of colorectal cancer with fecal occult blood testing and sigmoidoscopy. J Natl Cancer Inst. 1993;85:1311–1318.

    Article  PubMed  CAS  Google Scholar 

  4. Mandel JS, Church TR, Bond JH, et al. The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med. 2000;343:1603–1607.

    Article  PubMed  CAS  Google Scholar 

  5. Atkin WS, Cuzick J, Northover JM, Whynes DK. Prevention of colorectal cancer by once-only sigmoidoscopy. Lancet. 1993;341:736–740.

    Article  PubMed  CAS  Google Scholar 

  6. Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for faecal occult blood. N Engl J Med. 1993;328:1365e71.

    Google Scholar 

  7. Hardcastle JD, Chamberlain JO, Robinson MH, et al. Randomised controlled trial of faecal occult-blood screening for colorectal cancer. Lancet. 1996;348:1472–1477.

    Article  PubMed  CAS  Google Scholar 

  8. Kronborg O, Fenger C, Olsen J, Jørgensen OD, Søndergaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348:1467–1471.

    Article  PubMed  CAS  Google Scholar 

  9. Jørgensen OD, Kronborg O, Fenger C. A randomized study of screening for colorectal cancer using faecal occult blood testing: results after 13 years and seven biennial screening rounds. Gut. 2002;50:29–32.

    Article  PubMed  Google Scholar 

  10. Young GP, St John DJ, Winawer SJ, Rozen P; WHO (World Health Organization) and OMED (World Organization for Digestive Endoscopy). Choice of fecal occult blood test for screening: recommendations based on performance characteristics in population studies: a WHO (World Health Organization) and OMED (World Organization for Digestive Endoscopy) report. Am J Gastroenterol. 2002;97:2499–2507.

    Google Scholar 

  11. Grazzini G, Visioli CB, Zorzi M, et al. Immunochemical faecal occult blood test: number of samples and positivity cutoff. What is the best strategy for colorectal cancer screening? Br J Cancer. 2009;100:259–265.

    Article  PubMed  CAS  Google Scholar 

  12. Leiberman DA, Holub J, Eisen G, Kraemer D, Morris CD. Utilization of colonoscopy in the United States: results from a national consortium. Gastrointest Endosc. 2005;62:875–883.

    Article  Google Scholar 

  13. Guittet L, Bouvier V, Mariotte N, et al. Comparison of a guaiac based and an immunochemical faecal occult blood test in screening for colorectal cancer in a general average risk population. Gut. 2007;56:210–214.

    Article  PubMed  CAS  Google Scholar 

  14. Fenocchi E, Martinez L, Tolve J, et al. Screening for colorectal cancer in Uruguay with an immunochemical faecal occult blood test. Eur J Cancer Prev. 2006;15:384–390.

    Article  PubMed  Google Scholar 

  15. Rubeca T, Rapi S, Confortini M, et al. Evaluation of diagnostic accuracy of screening by fecal occult blood testing (FOBT). Comparison of FOB Gold and OC Sensor assays in a consecutive prospective screening series. Int J Biol Markers.. 2006;21:157–161.

    PubMed  CAS  Google Scholar 

  16. Grazzini G, Gastiglione G, Ciabattoni C, et al. Colorectal cancer screening programme by faecal occult blood test in Tuscany: first round results. Eur J Cancer Prev. 2004;13:19–26.

    Article  PubMed  CAS  Google Scholar 

  17. Sohn DK, Jeong SY, Choi HS, et al. Single immunochemical fecal occult blood test for detection of colorectal neoplasia. Cancer Res Treat.. 2005;37:20–23.

    Article  PubMed  Google Scholar 

  18. Castiglione G, Grazzini G, Miccinesi G, et al. Basic variables at different positivity thresholds of an quantitative immunochemical test for faecal occult blood. J Med Screen. 2002;9:99–103.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  20. Omata F, Shintani A, Isozaki M, et al. Diagnostic performance of quantitative fecal immunochemical test and multivariate prediction model for colorectal neoplasms in asymptomatic individuals. Eur J Gastroenterol Hepatol. 2011;23:1036–1041.

    PubMed  CAS  Google Scholar 

  21. Rozen P, Levi Z, Hazazi R, et al. Quantitative colonoscopic evaluation of relative efficiencies of an immunochemical faecal occult blood test and a sensitive guaiac test for detecting significant colorectal neoplasms. Aliment Pharmacol Ther. 2009;29:450–457.

    Google Scholar 

  22. Yoo KY. Cancer control activities in the republic of Korea. Jpn J Clin Oncol.. 2008;38:327–333.

    Article  PubMed  Google Scholar 

  23. Cha JM, Lee JI, Joo KR, Shin HP, Park JJ. Telephone reminder call in addition to mailing notification improved the acceptance rate of colonoscopy in patients with a positive fecal immunochemical test. Dig Dis Sci. 2011;56:3137–3142.

    Article  PubMed  Google Scholar 

  24. Fraser CG, Allison JE, Halloran SP, Young GP. Expert working group on fecal immunochemical tests for hemoglobin, colorectal cancer screening committee, world endoscopy organization. A proposal to standardize reporting units for fecal immunochemical tests for hemoglobin. J Natl Cancer Inst. 2012;104:810–814.

    Article  PubMed  CAS  Google Scholar 

  25. Terhaarsive Droste JS, Oort FA, van der Hulst RW, et al. Higher fecal immunochemical test cutoff levels: lower positivity rates but still acceptable detection rates for early-stage colorectal cancers. Cancer Epidemiol Biomarkers Prev. 2011;20:272–280.

    Google Scholar 

  26. Haug U, Hundt S, Brenner H. Quantitative immunochemical fecal occult blood testing for colorectal adenoma detection: evaluation in the target population of screening and comparison with qualitative tests. Am J Gastroenterol. 2010;105:682–690.

    Article  PubMed  Google Scholar 

  27. Levi Z, Rozen P, Hazazi R, et al. A quantitative immunochemical fecal occult blood test for colorectal neoplasia. Ann Intern Med. 2007;146:244–255.

    Article  PubMed  Google Scholar 

  28. Wilschut JA, Hol L, Dekker E, et al. Cost-effectiveness analysis of a quantitative immunochemical test for colorectal cancer screening. Gastroenterology. 2011;141:1648–1655.

    Article  PubMed  Google Scholar 

  29. Sobhani I, Alzahouri K, Ghout I, Charles DJ, Durand-Zaleski I. Cost-effectiveness of mass screening for colorectal cancer: choice of fecal occult blood test and screening strategy. Dis Colon Rectum. 2011;54:876–886.

    Article  PubMed  Google Scholar 

  30. Morikawa T, Kato J, Yamaji Y, et al. A comparison of the immunochemical fecal occult blood test and total colonoscopy in the asymptomatic population. Gastroenterology. 2005;129:422–428.

    PubMed  Google Scholar 

  31. Haug U, Kuntz KM, Knudsen AB, et al. Sensitivity of immunochemical faecal occult blood testing for detecting left- vs. right-sided colorectal neoplasia. Br J Cancer. 2011;104:1779–1785.

    Article  PubMed  CAS  Google Scholar 

  32. Baxter NN, Goldwasser MA, Paszat LF, et al. Association of colonoscopy and death from colorectal cancer: a population-based, case-control study. Ann Intern Med. 2009;150:1–8.

    Article  PubMed  Google Scholar 

  33. Brenner H, Chang-Claude J, Seiler CM, Rickert A, Hoffmeister M. Protection from colorectal cancer after colonoscopy: a population-based, case-control study. Ann Intern Med. 2011;154:22–30.

    Article  PubMed  Google Scholar 

  34. Van Rossum LG, Van Rijn AF, Laheij RJ, et al. Random comparison of guaiac and fecal immunochemical blood tests for colorectal cancer in a screening population. Gastroenterology. 2008;135:82–90.

    Article  PubMed  Google Scholar 

  35. Van Roon AH, Wilschut JA, Hol L, et al. Diagnostic yield improves with collection of 2 samples in fecal immunochemical test screening without affecting attendance. Clin Gastroenterol Hepatol.. 2011;9:333–339.

    Article  PubMed  Google Scholar 

  36. Cha JM, Lee JI, Joo KR, et al. Performance of the fecal immunochemical test is not decreased by high ambient temperature in the rapid return system. Dig Dis Sci. 2012;57:2178–2183.

    Article  PubMed  CAS  Google Scholar 

  37. Cha JM, Lee JI, Joo KR, Shin HP, Park JJ. Telephone reminder call in addition to mailing notification improved the acceptance rate of colonoscopy in patient with a positive fecal immunochemical test. Dig Dis Sci. 2011;56:3137–3142.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, 149 Sangil-dong, Gangdong-gu, Seoul, 134-727, South Korea

    Jae Myung Cha, Joung Il Lee, Kwang Ro Joo, Hyun Phil Shin, Jung Won Jeun & Jun Uk Lim

Authors
  1. Jae Myung Cha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joung Il Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kwang Ro Joo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hyun Phil Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jung Won Jeun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jun Uk Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jae Myung Cha.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cha, J.M., Lee, J.I., Joo, K.R. et al. Use of a Low Cut-Off Value for the Fecal Immunochemical Test Enables Better Detection of Proximal Neoplasia. Dig Dis Sci 58, 3256–3262 (2013). https://doi.org/10.1007/s10620-013-2819-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-013-2819-2

Keywords

Search

Navigation