Colorectal cancer test sensitivity varies by polyp location

  • Clin Epidemiol
  • 25.10.2019

  • von Craig Hicks
  • Studien – kurz & knapp
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Takeaway

  • Immunochemical fecal occult blood tests (iFOBTs) have higher sensitivity for detecting advanced adenomas and neoplasia in the distal colon and rectum than in the proximal colon.

Why this matters

  • iFOBTs are among the most widely used noninvasive tests for colorectal cancer (CRC) screening; clinicians interpreting screening results should consider potential differences in diagnostic accuracy, based on anatomical location.

Study design

  • Researchers analyzed 31 studies assessing iFOBT-based detection of colorectal neoplasms in the proximal colon, distal colon, and rectum (N range, 112-21,805; mean age range, 48-69 years), using a random effects model to calculate pooled sensitivities and specificities.
  • Funding: National Natural Science Foundation of China; Chinese Academy of Medical Sciences.

Key results

  • Researchers found no site-specific differences for iFOBT sensitivities related to CRC (proximal colon: 0.67 [95% CI, 0.62-0.72] vs distal colon/rectum: 0.72 [95% CI, 0.68-0.75]).
  • iFOBT had higher sensitivities for detecting distally located advanced adenomas (0.32; 95% CI, 0.30-0.34) and neoplasms (0.38; 95% CI, 0.36-0.40) than for proximally located advanced adenomas (0.24; 95% CI, 0.22-0.25) and neoplasms (0.25; 95% CI, 0.23-0.28).

Limitations

  • Studies had different designs, participant characteristics, and FOBT cutoff values.