ประสิทธิภาพการใช้ fecal immunochemical test ในการตรวจคัดกรองมะเร็งลำไส้ใหญ่และไส้ตรง โดยเปรียบเทียบค่า cut-off ที่ 50 นาโนกรัมต่อมิลลิลิตร และ 100 นาโนกรัมต่อมิลลิลิตร

อัจฉรีย์ เสรีศิริวัฒนา

Authors

อัจฉรีย์ เสรีศิริวัฒนา รพ.อุทัยธานี

Keywords:

colorectal cancer, colorectal cancer screening, fecal immunochemical test (FIT test), cut-off value, positive predictive value (PPV) and negative predictive value (NPV)

Abstract

Objective : Compare the FIT performance in detecting advanved neoplasia (advanced adenoma and colorectal carcinoma (CRC)) with different cut-offs value in PPV for accurate cut-off values for these patients, using two different cut-off values.

Method : Retrospective analytic study that include patient age 45-75 year-old with positive FIT test from hospital in Uthai thani provine, Thailand. And referred for colonoscopy in Uthaithani hospital between October 2018 to september 2020. We divided into 2 group : Group 1 was FIT test positive appled a cut-off 100 ng Hb/mL buffer (FIT100) and Group 2 was FIT test positive appled a cut-off 50 ng Hb/mL buffer (FIT50) prior to colonoscopy

Result : A total 850 participants, 318 patient (Woman 62.9%, aged 60.4±5.8 years in group 1 and 55.3% in group 2, aged 60.9±9.6 years) was included in this study. Advanced neoplasia (advanced adenoma and CRC) in FIT100 and FIT50 were found in 6 (3.8%) and 32 (20.1%), respectively. Distal advanced neoplasia (Odd ratio 2.67, 95%CI 0.82-8.67) was higher than for proximal advanced neoplasia in FIT50, difference was statistically significant (p>0.05).

For advanced neoplasia, FIT100 was sensitivity 100.0%, specificity 64.1%, PPV 9.8%, NPV 100.0% and false positive rate 35.9% , FIT50 was sensitivity 100.0%, specificity 48.0%, PPV32.7%, NPV100.0% and false positive rate 51.9%. Gastrointestinal symptoms was effected to advanced neoplasia in FIT 50, positive FIT50 with Gastrointestinal symptoms was higher than positive FIT50 without gastrointestinal symptoms (OR 11.74, 95%CI 1.54-89.32, P value <0.01) in advanced neoplasia. Positive FIT50 with Gastrointestinal symptoms was sensitivity 100.0%, specificity 48.9%, PPV 38.9%, NPV 100.0% and false positive rate 51.1%.

In subgroup analysis positive FIT test without symptoms was sensitivity 100.0%, specificity 64.3%, PPV 11.5%, NPV 100%, false positive rate 35.7% in FIT100 and sensitivity 100.0%, specificity 45.0%,PPV9.5%, NPV100.0%, false positive rate 54.3% in FIT50. A decreased cut-off decrease specificity (from 64.3% to 45.0%) and PPV (from11.5% to 9.5%).

Conclusion : FIT100 was specificity and PPV higher than FIT50 in average-risk population without gastrointestinal symptom in screening colorectal cancer. And decrease false positive rate. It is a decreased colonoscopy workload. In average-risk population with gastrointestinal symptom, FIT50 can used for colorectal cancer screening due to PPV higher than FIT100 and it is a helpful test to perform further studies.

Keywords : colorectal cancer, colorectal cancer screening, fecal immunochemical test (FIT test), cut-off value, positive predictive value (PPV) and negative predictive value (NPV)

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