Systematic review with meta‐analysis: faecal occult blood tests show lower colorectal cancer detection rates in the proximal colon in colonoscopy‐verified diagnostic studies

Alimentary Pharmacology and Therapeutics - Tập 43 Số 7 - Trang 755-764 - 2016
Hoyee W. Hirai1,2,3, Kelvin K.F. Tsoi2,3, Joyce Y.C. Chan2, Sam Wong4,4, Jessica Y. L. Ching1, Martin C. S. Wong1,2, J Wu4,4, Francis K.L. Chan4,4, Joseph J.�Y. Sung4,4, Siew C. Ng4,4
1Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
2School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
3Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong
4Department of Medicine and Therapeutics LKS Institute of Health Science State Key Laboratory of Digestive Disease The Chinese University of Hong Kong Shatin Hong Kong

Tóm tắt

SummaryBackgroundThe performance of faecal occult blood tests (FOBTs) to screen proximally located colorectal cancer (CRC) has produced inconsistent results.AimTo assess in a meta‐analysis, the diagnostic accuracy of FOBTs for relative detection of CRC according to anatomical location of CRC.MethodsDiagnostic studies including both symptomatic and asymptomatic cohorts assessing performance of FOBTs for CRC were searched from MEDINE and EMBASE. Primary outcome was accuracy of FOBTs according to the anatomical location of CRC. Bivariate random‐effects model was used. Subgroup analyses were performed to evaluate test performance of guaiac‐based FOBT (gFOBT) and immunochemical‐based FOBT (iFOBT).ResultsThirteen studies, with 17 cohorts, reporting performance of FOBT were included; a total of 26 342 patients (mean age 58.9 years; 58.1% male) underwent both colonoscopy and FOBT. Pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of FOBTs for CRC detection in the proximal colon were 71.2% (95% CI 61.3–79.4%), 93.6% (95% CI 90.7–95.7%), 11.1 (95% CI 7.8–15.8) and 0.3 (95% CI 0.2–0.4) respectively. Corresponding findings for CRC detection in distal colon were 80.1% (95% CI 70.9–87.0%), 93.6% (95% CI 90.7–95.7%), 12.6 (95% CI 8.8–18.1) and 0.2 (95% CI 0.1–0.3). The area‐under‐curve for FOBT detection for proximal and distal CRC were 90% vs. 94% (P = 0.0143). Both gFOBT and iFOBT showed significantly lower sensitivity but comparable specificity for the detection of proximally located CRC compared with distal CRC.ConclusionFaecal occult blood tests, both guaiac‐ and immunochemical‐based, show better diagnostic performance for the relative detection of colorectal cancer in the distal colon than in the proximal bowel.

Từ khóa


Tài liệu tham khảo

10.3322/caac.21208

10.1136/gutjnl-2013-306503

10.1056/NEJM200011303432203

10.1056/NEJM199305133281901

10.7326/0003-4819-113-5-403

10.1002/1097-0142(19800315)45:5 <1099::AID-CNCR2820451312>3.0.CO;2-T

10.1016/j.ejca.2013.04.023

10.1038/ajg.2010.179

10.1007/s00535-010-0214-8

10.1097/CEJ.0b013e32835b6991

10.1056/NEJM199601183340304

10.1038/bjc.1996.329

10.1136/bmj.296.6629.1092

10.1002/bjs.1800810343

10.7326/M13-1484

10.1097/MEG.0000000000000160

10.1007/s11606-010-1375-0

10.1016/j.cca.2010.02.057

10.1258/096914103769011012

10.1016/j.canlet.2004.12.011

10.7326/0003-4819-117-5-376

10.7326/0003-4819-151-4-200908180-00135

10.7326/0003-4819-149-12-200812160-00008

Macaskill P, Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version 1.0

10.7326/0003-4819-155-8-201110180-00009

10.7326/0003-4819-138-1-200301070-00012-w1

Reitsma JB, 2005, Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews, J ClinEpidemiol, 58, 982

10.1016/S0895-4356(03)00177-X

10.1002/sim.942

10.1002/(SICI)1097-0258(19980430)17:8<857::AID-SIM777>3.0.CO;2-E

10.1016/0197-2456(86)90046-2

10.2147/CLEP.S7097

10.1016/j.cgh.2013.01.013

10.1136/gut.39.5.722

10.1016/j.ijsu.2013.02.013

10.1371/journal.pone.0106182

10.1158/1055-9965.EPI-13-0512

10.1136/bmjopen-2013-003989

10.1111/j.1572-0241.2008.01824.x

10.1053/gast.2003.50090

10.1038/bjc.1992.125

10.1016/j.cgh.2013.01.013

10.1002/ijc.24458

10.1002/(SICI)1097-0142(19970715)80:2<193::AID-CNCR4>3.0.CO;2-V

10.1177/2150131913487561

Thông tin
Thông tin xuất bản

Alimentary Pharmacology and Therapeutics

Tập 43 Số 7

755-764

Thông tin tác giả