CRC: single FIT shows moderate to high sensitivity, specificity

  • Imperiale TF & al.
  • Ann Intern Med
  • 26 Feb 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • A single fecal immunochemical test (FIT) demonstrated moderate to high specificity and sensitivity for colorectal cancer (CRC), but low sensitivity for advanced adenomas in a large meta-analysis of asymptomatic, average-risk adults.

Why this matters

  • FIT has the potential to increase CRC screening rates in the United States.

Study design

  • Systematic review and meta-analysis of 31 articles (n=120,255) that included 18 FITs.
  • Funding: Indiana University.

Key results

  • The most commonly studied FIT was OC-Sensor (Eiken Chemical, 58% of studies).
  • CRC sensitivity/specificity by threshold:
    • 10 µg/g: sensitivity, 0.91 (95% CI, 0.84-0.95); negative likelihood ratio, 0.10 (95% CI, 0.06-0.19).
    • >20 µg/g: specificity, 0.95 (95% CI, 0.94-0.96); positive likelihood ratio, 15.49 (95% CI, 9.82-22.39).
  • Advanced adenoma sensitivity/specificity by threshold:
    • 10 µg/g: sensitivity, 0.40 (95% CI, 0.33-0.47); negative likelihood ratio, 0.67 (95% CI, 0.57-0.78).
    • >20 µg/g: specificity, 0.95 (95% CI, 0.94-0.96); positive likelihood ratio, 5.86 (95% CI, 3.77-8.97).
  • For CRC, at a threshold of 10 µg/g, 1 qualitative FIT had a sensitivity of 0.90 and a specificity of 0.91, with a positive likelihood ratio of 10.13 and a negative likelihood ratio of 0.11.

Limitations

  • Study included only 1-time testing, not serial testing.

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