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Logo of bmcgastBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Gastroenterology
 
BMC Gastroenterol. 2012; 12: 94.
Published online Jul 24, 2012. doi:  10.1186/1471-230X-12-94
PMCID: PMC3444435
Faecal immunochemical test accuracy in patients referred for surveillance colonoscopy: a multi-centre cohort study
Jochim S Terhaar sive Droste,corresponding author1,9 Sietze T van Turenhout,1 Frank A Oort,1 René WM van der Hulst,2 Vincent A Steeman,1 Usha Coblijn,1 Lisette van der Eem,1 Ruud Duijkers,1 Anneke A Bouman,3 Gerrit A Meijer,4 Annekatrien CTM Depla,5 Pieter Scholten,6 Ruud JLF Loffeld,7 Veerle MH Coupé,8 and Chris JJ Mulder1
1Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
2Gastroenterology and Hepatology, Kennemer Gasthuis, Haarlem, The Netherlands
3Clinical Chemistry, VU University Medical Centre, Amsterdam, The Netherlands
4Pathology, VU University Medical Centre, Amsterdam, The Netherlands
5Gastroenterology and Hepatology, Slotervaart Hospital, Amsterdam, The Netherlands
6Gastroenterology and Hepatology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
7Internal Medicine, Zaans Medical Centre, Zaandam, The Netherlands
8Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
9Department of Gastroenterology and Hepatology, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
corresponding authorCorresponding author.
Jochim S Terhaar sive Droste: js.terhaar/at/vumc.nl; Sietze T van Turenhout: s.vanturenhout/at/vumc.nl; Frank A Oort: f.oort/at/vumc.nl; René WM van der Hulst: hulst/at/kg.nl; Vincent A Steeman: vsteeman/at/me.com; Usha Coblijn: usha.coblijn/at/gmail.com; Lisette van der Eem: lisettevandereem/at/gmail.com; Ruud Duijkers: r.duijkers/at/student.vu.nl; Anneke A Bouman: a.bouman/at/vumc.nl; Gerrit A Meijer: ga.meijer/at/vumc.nl; Annekatrien CTM Depla: actm.depla/at/slz.nl; Pieter Scholten: p.scholten/at/slaz.nl; Ruud JLF Loffeld: loffeld.r/at/zaansmc.nl; Veerle MH Coupé: v.coupe/at/vumc.nl; Chris JJ Mulder: cjmulder/at/vumc.nl
Received January 10, 2012; Accepted July 24, 2012.
Abstract
Background
Given the increasing burden on colonoscopy capacity, it has been suggested that faecal immunochemical test (FIT) results could guide surveillance colonoscopy intervals. Against this background, we have evaluated the test accuracy of single and double FIT sampling to detect colorectal cancer (CRC) and/or advanced adenomas in an asymptomatic colonoscopy-controlled high-risk population.
Methods
Cohort study of asymptomatic high-risk patients (personal history of adenomas/CRC or family history of CRC), who provided one or two FITs before elective colonoscopy. Test accuracy of FIT for detection of CRC and advanced adenomas was determined (cut-off level 50 ng/ml).
Results
1,041 patients provided a FIT (516 personal history of adenomas, 172 personal history of CRC and 353 family history of CRC). Five CRCs (0.5%) and 101 advanced adenomas (9.7%) were detected by colonoscopy. Single FIT sampling resulted in a sensitivity, specificity, PPV and NPV for CRC of 80%, 89%, 3% and 99.9%, respectively, and for advanced adenoma of 28%, 91%, 24% and 92%, respectively. Double FIT sampling did not result in a significantly higher sensitivity for advanced neoplasia. Simulation of multiple screening rounds indicated that sensitivity of FIT for advanced adenoma could reach 81% after 5 screening rounds.
Conclusions
In once-only FIT sampling before surveillance colonoscopy, 70% of advanced neoplasia were missed. A simulation approach indicates that multiple screening rounds may be more promising in detecting advanced neoplasia and could potentially alleviate endoscopic burden.
Keywords: Colorectal cancer, Faecal immunochemical test (FIT), Surveillance, Advanced adenoma, Sensitivity
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