Advertisement

Digestive Diseases and Sciences

, Volume 60, Issue 5, pp 1424–1432 | Cite as

Diagnostic Performance of Fecal Immunochemical Test and Sigmoidoscopy for Advanced Right-Sided Colorectal Neoplasms

  • Inés Castro
  • Pamela Estevez
  • Joaquín Cubiella
  • Vicent Hernandez
  • Carmen González-Mao
  • Concepción Rivera
  • Felipe Iglesias
  • Lucía Cid
  • Santiago Soto
  • Luisa de-Castro
  • Pablo Vega
  • Jose Antonio Hermo
  • Ramiro Macenlle
  • Alfonso Martínez
  • Estela Cid
  • Inés Gil
  • Mikel Larzabal
  • Luis Bujanda
  • Antoni Castells
  • the COLONPREV study investigators
Original Article

Abstract

Background

Colorectal cancer screening effect on right-sided colorectal neoplasia is limited. We compared fecal immunochemical test and simulated sigmoidoscopy diagnostic accuracy for advanced right-sided neoplasia detection.

Methods

We analyzed 1,292 individuals with complete screening colonoscopy with a fecal immunochemical test determination before colonoscopy. Sigmoidoscopy and “hybrid strategy” (sigmoidoscopy or fecal hemoglobin concentration ≥20 µg hemoglobin/g) diagnostic yield were simulated according to UK Flexible Sigmoidoscopy, Screening for COlon REctum (SCORE), and Norwegian Colorectal Cancer Prevention (NORCCAP) trials criteria to complete colonic examination. We compared sensitivity and specificity of both strategies and of “hybrid strategy” for advanced right-sided neoplasia with McNemar test.

Results

An advanced right-sided neoplasia was detected in 47 (3.6 %) subjects. A fecal hemoglobin concentration ≥20 µg hemoglobin/g was determined in 6.6 % of the subjects and 10.1, 12.7, and 23.5 % met UK, SCORE, and NORCCAP criteria, respectively. Fecal immunochemical test was statistically more specific than sigmoidoscopy strategies (93.8 %, UK 90.3 %, SCORE 87.7 %, NORCCAP 77.8 %; p < 0.001). In contrast, fecal immunochemical test sensitivity for advanced right-sided neoplasia (17 %) was not statistically different than UK (21.3 %; p = 0.7) or SCORE (23.4 %; p = 0.5), although it was inferior than NORCCAP strategy (42.5 %; p < 0.001). Adding fecal immunochemical test to sigmoidoscopy increased number of positives (8.5–25.7 %), sensitivity (10–30 %), and significantly reduced advanced right-sided neoplasia specificity (p < 0.001).

Conclusions

Fecal immunochemical test and sigmoidoscopy diagnostic yield for advanced right-sided neoplasia are low. Fecal immunochemical test is more specific than sigmoidoscopy but less sensitive than sigmoidoscopy according to NORCCAP criteria.

Keywords

Colorectal neoplasm Fecal immunochemical test Sigmoidoscopy Colonoscopy Colorectal cancer screening 

Notes

Acknowledgments

This study was supported by grants from the Conselleria de Sanidade of Xunta de Galicia (PS09/74), Academia Médico Quirúrgica of Ourense, Instituto de Salud Carlos III (PI08/90717), Obra Social de Kutxa, Diputación Foral de Gipuzkoa (DFG 07/5), Departamento de Sanidad del Gobierno Vasco, EITB-Maratoia (BIO 07/CA/19), and Acción Transversal contra el Cáncer del CIBERehd (2008). This work was also supported by Dirección Xeral de Innovación e Xestión da Saúde Pública, Conselleria de Sanidade, Xunta de Galicia. The study sponsors had no involvement in the collection, analysis, and interpretation of data, writing of the manuscript, or in the decision to submit the manuscript for publication.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10620_2014_3434_MOESM1_ESM.docx (280 kb)
Supplementary material 1 (DOCX 279 kb)
10620_2014_3434_MOESM2_ESM.docx (17 kb)
Supplementary material 2 (DOCX 17 kb)

References

  1. 1.
    Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095–2128.CrossRefPubMedGoogle Scholar
  2. 2.
    Hewitson P, Glasziou P, Watson E, et al. Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update. Am J Gastroenterol. 2008;103:1541–1549.CrossRefPubMedGoogle Scholar
  3. 3.
    Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134:1570–1595.CrossRefPubMedGoogle Scholar
  4. 4.
    Atkin WS, Edwards R, Kralj-Hans I, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet.. 2010;375:1624–1633.CrossRefPubMedGoogle Scholar
  5. 5.
    Lansdorp-Vogelaar I, Knudsen AB, Brenner H. Cost-effectiveness of colorectal cancer screening. Epidemiol Rev. 2011;33:88–100.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Holme O, Bretthauer M, Fretheim A, et al. Flexible sigmoidoscopy versus fecal occult blood testing for colorectal cancer screening in asymptomatic individuals. Cochrane database Syst Rev. 2013;9:CD009259.PubMedGoogle Scholar
  7. 7.
    Sharp L, Tilson L, Whyte S, et al. Cost-effectiveness of population-based screening for colorectal cancer: a comparison of guaiac-based fecal occult blood testing, fecal immunochemical testing and flexible sigmoidoscopy. Br J Cancer. 2012;106:805–816.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Elmunzer BJ, Hayward RA, Schoenfeld PS, et al. Effect of flexible sigmoidoscopy-based screening on incidence and mortality of colorectal cancer: a systematic review and meta-analysis of randomized controlled trials. PLoS Med. 2012;9:e1001352.CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Imperiale TF, Wagner DR, Lin CY, Larkin, et al. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med. 2000;343:169–174.CrossRefPubMedGoogle Scholar
  10. 10.
    Segnan N, Armaroli P, Bonelli L, et al. Once-only sigmoidoscopy in colorectal cancer screening: follow-up findings of the Italian Randomized Controlled Trial–SCORE. J Natl Cancer Inst. 2011;103:1310–1322.CrossRefPubMedGoogle Scholar
  11. 11.
    Schoen RE, Pinsky PF, Weissfeld JL, et al. Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy. N Engl J Med. 2012;366:2345–2357.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Park DI, Ryu S, Kim Y-H, 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.CrossRefPubMedGoogle Scholar
  13. 13.
    Hol L, van Leerdam ME, van Ballegooijen M, et al. Screening for colorectal cancer: randomised trial comparing guaiac-based and immunochemical fecal occult blood testing and flexible sigmoidoscopy. Gut. 2010;59:62–68.CrossRefPubMedGoogle Scholar
  14. 14.
    Haug U, Knudsen AB, Brenner H, et al. Is fecal occult blood testing more sensitive for left-versus right-sided colorectal neoplasia? A systematic literature review. Expert Rev Mol Diagn. 2011;11:605–616.CrossRefPubMedGoogle Scholar
  15. 15.
    Segnan N, Senore C, Andreoni B, et al. Randomized trial of different screening strategies for colorectal cancer: patient response and detection rates. J Natl Cancer Inst. 2005;97:347–357.CrossRefPubMedGoogle Scholar
  16. 16.
    Segnan N, Senore C, Andreoni B, et al. Comparing attendance and detection rate of colonoscopy with sigmoidoscopy and FIT for colorectal cancer screening. Gastroenterology.. 2007;132:2304–2312.CrossRefPubMedGoogle Scholar
  17. 17.
    Littlejohn C, Hilton S, Macfarlane GJ, et al. Systematic review and meta-analysis of the evidence for flexible sigmoidoscopy as a screening method for the prevention of colorectal cancer. Br J Surg. 2012;99:1488–1500.CrossRefPubMedGoogle Scholar
  18. 18.
    Hernandez V, Cubiella J, Gonzalez-Mao MC, et al. Fecal immunochemical test accuracy in average-risk colorectal cancer screening. World J Gastroenterol. 2014;20:1038–1047.CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Castro I, Cubiella J, Rivera C, et al. Fecal immunochemical test accuracy in familial risk colorectal cancer screening. Int J Cancer. 2014;134:367–375.CrossRefPubMedGoogle Scholar
  20. 20.
    Quintero E, Castells A, Bujanda L, et al. Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med. 2012;366:697–706.CrossRefPubMedGoogle Scholar
  21. 21.
    Salas D. Situación de los programas de cribado de cáncer colorrectal en España. Situación 2006–14. http://www.programascancerdemama.org/images/archivos/colorrectal/situacion/Implantacion%20CCCR%20en%20Espa%C3%B1a%202014.pdf. Accessed Nov 2014.
  22. 22.
    Jover R, Herráiz M, Alarcón O, et al. Clinical practice guidelines: quality of colonoscopy in colorectal cancer screening. Endoscopy. 2012;44:444–451.CrossRefPubMedGoogle Scholar
  23. 23.
    Bretthauer M, Gondal G, Larsen K, et al. Design, organization and management of a controlled population screening study for detection of colorectal neoplasia: attendance rates in the NORCCAP study (Norwegian Colorectal Cancer Prevention). Scand J Gastroenterol. 2002;37:568–573.CrossRefPubMedGoogle Scholar
  24. 24.
    Castells A, Bessa X, Quintero E, et al. Risk of advanced proximal neoplasms according to distal colorectal findings: comparison of sigmoidoscopy-based strategies. J Natl Cancer Inst. 2013;105:878–886.CrossRefPubMedGoogle Scholar
  25. 25.
    Castells A, Quintero E, Alvarez C, el al. Rate of detection of advanced neoplasms in proximal colon by simulated sigmoidoscopy vs fecal immunochemical tests. Clin Gastroenterol Hepatol. 2014;12:1708–1716.CrossRefPubMedGoogle Scholar
  26. 26.
    Cubiella J, Salve M, Díaz-Ondina M, et al. Diagnostic accuracy of fecal immunochemical test for colorectal cancer in symptomatic patients: comparison with NICE and SIGN referral criteria. Colorectal Dis. 2014;16:O273–O282.CrossRefPubMedGoogle Scholar
  27. 27.
    Gonzalo V, Lozano JJ, Muñoz J, et al. Aberrant gene promoter methylation associated with sporadic multiple colorectal cancer. PLoS One. 2010;5:e8777.CrossRefPubMedCentralPubMedGoogle Scholar
  28. 28.
    Ogino S, Kawasaki T, Kirkner GJ, et al. Molecular correlates with MGMT promoter methylation and silencing support CpG island methylator phenotype-low (CIMP-low) in colorectal cancer. Gut. 2007;56:1564–1571.CrossRefPubMedCentralPubMedGoogle Scholar
  29. 29.
    Taupin DR, Corbett M. A comparison of colorectal neoplasia screening tests: a multicentre community-based study of the impact of consumer choice. Med J Aust. 2006;185:238–239.PubMedGoogle Scholar
  30. 30.
    Gondal G, Grotmol T, Hofstad B, et al. The Norwegian Colorectal Cancer Prevention (NORCCAP) screening study: baseline findings and implementations for clinical work-up in age groups 50–64 years. Scand J Gastroenterol. 2003;38:635–642.CrossRefPubMedGoogle Scholar
  31. 31.
    Hoff G, Grotmol T, Skovlund E, et al. Risk of colorectal cancer seven years after flexible sigmoidoscopy screening: randomised controlled trial. BMJ. 2009;338:b1846.CrossRefPubMedCentralPubMedGoogle Scholar
  32. 32.
    Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, et al. Evaluating test strategies for colorectal cancer screening: a decision analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;149:659–669.CrossRefPubMedCentralPubMedGoogle Scholar
  33. 33.
    Kato J, Morikawa T, Kuriyama M, et al. Combination of sigmoidoscopy and a fecal immunochemical test to detect proximal colon neoplasia. Clin Gastroenterol Hepatol.. 2009;7:1341–1346.CrossRefPubMedGoogle Scholar
  34. 34.
    Wang YR, Cangemi JR, Loftus EV, et al. Increased odds of interval distal colorectal cancer after flexible sigmoidoscopy compared with colonoscopy in older patients in the United States: a population-based analysis of the SEER-Medicare linked database, 2001–2005. Mayo Clin Proc. 2013;88:471–478.CrossRefPubMedGoogle Scholar
  35. 35.
    Imperiale TF, Glowinski EA, Lin-Cooper C, et al. Tailoring colorectal cancer screening by considering risk of advanced proximal neoplasia. Am J Med. 2012;125:1181–1187.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Inés Castro
    • 1
  • Pamela Estevez
    • 2
    • 3
  • Joaquín Cubiella
    • 1
    • 7
  • Vicent Hernandez
    • 2
    • 3
  • Carmen González-Mao
    • 3
    • 4
  • Concepción Rivera
    • 1
  • Felipe Iglesias
    • 2
  • Lucía Cid
    • 2
    • 3
  • Santiago Soto
    • 1
  • Luisa de-Castro
    • 2
    • 3
  • Pablo Vega
    • 1
  • Jose Antonio Hermo
    • 2
  • Ramiro Macenlle
    • 1
  • Alfonso Martínez
    • 2
    • 3
  • Estela Cid
    • 1
  • Inés Gil
    • 5
  • Mikel Larzabal
    • 5
  • Luis Bujanda
    • 5
  • Antoni Castells
    • 6
  • the COLONPREV study investigators
  1. 1.Department of GastroenterologyComplexo Hospitalario Universitario de OurenseOurenseSpain
  2. 2.Department of GastroenterologyComplexo Hospitalario Universitario de VigoVigoSpain
  3. 3.‘IBIV’ Institute of Biomedical Research of VigoVigoSpain
  4. 4.Department of Clinical AnalysisComplexo Hospitalario Universitario de VigoVigoSpain
  5. 5.Donostia Hospital, Biodonostia InstituteUniversity of the Basque Country UPV/EHU, CIBERehdDonostia-San SebastiánSpain
  6. 6.Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPSUniversity of BarcelonaBarcelonaSpain
  7. 7.Gastroenterology DepartmentComplexo Hospitalario Universitario de OurenseOurenseSpain

Personalised recommendations