定量粪便免疫化学试验对有症状的结直肠癌患者的诊断准确性，一旦考虑贫血严重程度和缺铁

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2025-02-07 DOI:10.1111/codi.70024

James Lucocq, Emma Barron, Heather Holmes, Peter D. Donnelly, Neil Cruickshank

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引用次数: 0

摘要

目的本研究的目的是确定粪便免疫化学试验（FIT）对不同贫血严重程度或缺铁症状的结直肠癌（CRC）患者的诊断准确性。方法对2018-2021年就诊的有症状的结直肠癌患者进行前瞻性随访2年。将FIT亚组的CRC阳性预测值（PPV）在贫血严重程度组和缺铁组之间进行比较，并根据症状类型和人口统计学进行分层。研究了FIT对不同定义的缺铁性贫血（IDA） CRC的诊断准确性。结果共调查有症状患者17 538例，其中结直肠癌310例（1.8%）。在FIT 100 μg血红蛋白(Hb)/g亚组中，CRC的PPV在贫血严重程度之间没有变化（p > 0.05）。在FIT <； 100 μg Hb/g组中，存在IDA、非缺铁性贫血和无贫血缺铁性贫血的CRC PPV没有变化（p > 0.05）。在贫血和IDA亚组中，FIT 10-19 μg Hb/g对结直肠癌的PPV为lt；3%，假设将FIT临界值提高到20 μg Hb/g可以节省28.6%的结肠镜检查。在IDA定义中加入转铁蛋白饱和度增加了fit阴性患者CRC的检出率（敏感性9.1% vs. 3.9%），但CRC检出率较低(PPV = 0.6%；每个结直肠癌患者进行165次结肠镜检查)。研究fit阴性的功能性IDA将使CRC的检出率提高1.3%，但PPV为0.5%。结论无论贫血程度、缺铁程度、症状类型或人口统计学特征如何，FIT的诊断准确率均较高。无论贫血严重程度或缺铁情况如何，FIT临界值都可以安全地提高到20 μg Hb/g。改变IDA的定义实际上并没有增加阴性/低FIT患者CRC的检出率。

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Diagnostic accuracy of quantitative faecal immunochemical test in symptomatic patients for the investigation of colorectal cancer once accounting for anaemia severity and iron deficiency

Aim

The aim of this study was to determine the diagnostic accuracy of the faecal immunochemical test (FIT) for colorectal cancer (CRC) in symptomatic patients with different levels of anaemia severity or the presence of iron deficiency.

Method

Symptomatic patients (2018–2021) from primary care were followed up prospectively for CRC for 2 years. The positive predictive values (PPV) for CRC of FIT subgroups were compared between anaemia severity groups and iron deficiency groups once stratified for symptom type and demographics. The diagnostic accuracy of FIT for CRC was investigated for different definitions of iron deficiency anaemia (IDA).

Results

A total of 17 538 symptomatic patients were investigated, including 310 with CRC (1.8%). In FIT < 100 μg haemoglobin (Hb)/g subgroups, the PPV for CRC was unchanged between anaemia severity levels (p > 0.05). In groups with FIT < 100 μg Hb/g, the PPV for CRC was unchanged in the presence of IDA, non-iron-deficiency anaemia and iron deficiency without anaemia (p > 0.05). In the anaemia and IDA subgroups investigated, FIT 10–19 μg Hb/g had a PPV of <3% for CRC and increasing the FIT cut-off to 20 μg Hb/g could have hypothetically saved 28.6% of colonoscopies. Including transferrin saturation in the definition of IDA increased the detection of CRC in FIT-negative patients (sensitivity 9.1% vs. 3.9%) but with a low CRC pick-up rate (PPV = 0.6%; 165 colonoscopies per CRC). Investigating FIT-negative functional IDA would increase the detection of CRC by 1.3% but with a PPV of 0.5%.

Conclusion

The diagnostic accuracy of FIT is excellent regardless of the severity of anaemia, iron deficiency, symptom type or demographics. The FIT cut-off can be increased safely to 20 μg Hb/g irrespective of anaemia severity or iron deficiency. Altering the definition of IDA does not pragmatically increase the detection of CRC in negative/low FIT patients.

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.