Effect of Sex, Age, and Positivity Threshold on Fecal Immunochemical Test Accuracy: A Systematic Review and Meta-analysis.

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State: Public
Version: Author's accepted manuscript
License: Not specified
Serval ID
serval:BIB_84316A700BAC
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Effect of Sex, Age, and Positivity Threshold on Fecal Immunochemical Test Accuracy: A Systematic Review and Meta-analysis.
Journal
Gastroenterology
Author(s)
Selby K., Levine E.H., Doan C., Gies A., Brenner H., Quesenberry C., Lee J.K., Corley D.A.
ISSN
1528-0012 (Electronic)
ISSN-L
0016-5085
Publication state
Published
Issued date
12/2019
Peer-reviewed
Oui
Volume
157
Number
6
Pages
1494-1505
Language
english
Notes
Publication types: Journal Article ; Meta-Analysis ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Systematic Review
Publication Status: ppublish
Abstract
Quantitative fecal immunochemical tests (FITs) for hemoglobin are commonly used for colorectal cancer (CRC) screening. We aimed to quantify the change in CRC and advanced adenoma detection and number of positive test results at different positivity thresholds and by sex and age.
We searched MEDLINE and EMBASE, selecting articles of FIT for CRC detection in asymptomatic adults undergoing screening. We calculated sensitivity and specificity, as well as detected number of cancers, advanced adenomas, and positive test results at positivity thresholds ≤10 μg hemoglobin/g feces, 10 to ≤20 μg/g, 20 to ≤30 μg/g, and >30 μg/g. We also analyzed results from stratified by patient sex, age, and reference standard.
Our meta-analysis comprised 46 studies with 2.4 million participants and 6478 detected cancers. Sensitivity for detection of CRC increased from 69% (95% confidence interval [CI], 63%-75%) at thresholds >10 μg/g and ≤20 μg/g to 80% (95% CI, 76%-83%) at thresholds ≤10 μg/g. At these threshold values, sensitivity for detection of advanced adenomas increased from 21% (95% CI, 18%-25%) to 31% (95% CI, 27%-35%), whereas specificity decreased from 94% (95% CI, 93%-96%) to 91% (95% CI, 89%-93%). In 3 studies stratified by sex, sensitivity of CRC detection was 77% in men (95% CI, 75%-79%) and 81% in women (95% CI, 60%-100%) (P = .68). In 3 studies stratified by age groups, sensitivity of CRC detection was 85% for ages 50-59 years (95% CI, 71%-99%) and 73% for ages 60-69 years (95% CI, 71%-75%) (P = .10). All studies with colonoscopy follow-up had similar sensitivity levels for detection of CRC to studies that analyzed 2-year registry follow-up data (74%; 95% CI, 68%-78% vs 75%; 95% CI, 73%-77%).
In a meta-analysis of studies that analyzed detection of CRC and advanced adenomas at different FIT positivity thresholds, we found the sensitivity and specificity of detection to vary with positive cutoff value. It might be possible to decrease positive threshold values for centers with sufficient follow-up colonoscopy resources. More research is needed to precisely establish FIT thresholds for each sex and age subgroup.
PROSPERO CRD42017068760.
Keywords
Adenoma/diagnosis, Age Factors, Colonoscopy, Colorectal Neoplasms/diagnosis, Early Detection of Cancer/methods, Early Detection of Cancer/standards, Hemoglobins/analysis, Humans, Mass Screening/methods, Mass Screening/standards, Occult Blood, Reference Standards, Sensitivity and Specificity, Sex Factors, Advanced Neoplasia, Colon Cancer, Diagnostic Performance, Fecal Occult Blood Test
Pubmed
Web of science
Open Access
Yes
Create date
13/09/2019 18:59
Last modification date
04/03/2020 7:26
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