Correlation of Fecal Immunochemical Testing Levels With Pathology Results in a National Colorectal Cancer Screening Program
Open Access
- 1 January 2021
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical and Translational Gastroenterology
- Vol. 12 (1), e00277
- https://doi.org/10.14309/ctg.0000000000000277
Abstract
INTRODUCTION: Fecal immunochemical testing (FIT) positivity is determined by a threshold decided by individual screening programs. Data are limited on correlation between FIT levels and pathology identified at colonoscopy. Our aim was to examine the correlation between FIT levels and pathology identified in a national colorectal cancer screening program. METHODS: FIT levels (n = 9,271) were analyzed and correlated with patient demographics and pathology identified, including adenomas, sessile serrated lesions, number/size of adenomas, and presence of dysplasia. Levels were divided into 2 categories: FIT levels were defined as “high” or “low” based on whether they were above or below the median (479 ngHb/mL). Multivariate analysis was performed. RESULTS: A total of 8,084 patients (87%) underwent colonoscopy. Those younger than 65 years (odds ratio [OR] 1.267, 95% confidence interval [CI] 1.107–1.45, P = 0.001), those with an adenoma >10 mm (OR 1.736, 95% CI 01.512–1.991, P < 0.001), and those with left-sided adenomas (OR 1.484, 95% CI 1.266–1.74, P < 0.001) had higher FIT levels. Cancers (OR 2.8, 95% CI 2.09–3.75, P < 0.001) and high-grade dysplasia (OR 1.356, 95% CI 1.08–1.7, P = 0.008) had higher FIT levels, but varied greatly. The number of adenomas was not significant. DISCUSSION: In this study, FIT levels were high for left-sided and large adenomas, suggesting that FIT has poor sensitivity for detection of diminutive and right-sided neoplasia. FIT levels had no association with gender and declined with age. Adenoma burden did not correlate with FIT levels; this is a novel finding. FIT levels vary greatly even in those with advanced neoplasia; therefore, FIT is unlikely to be useful as a risk stratification tool.Keywords
This publication has 22 references indexed in Scilit:
- Attitudes towards the Faecal Occult Blood Test (FOBT) versus the Faecal Immunochemical Test (FIT) for colorectal cancer screening: perceived ease of completion and disgustBMC Cancer, 2016
- UK guidance for the pathological reporting of serrated lesions of the colorectumJournal of Clinical Pathology, 2015
- Characteristics of Adenomas Detected by Fecal Immunochemical Test in Colorectal Cancer ScreeningCancer Epidemiology, Biomarkers & Prevention, 2014
- A Population-based Comparison of Immunochemical Fecal Occult Blood Tests for Colorectal Cancer ScreeningGastroenterology, 2013
- Serrated polyps of the colon: how reproducible is their classification?Virchows Archiv, 2012
- Baseline faecal occult blood concentration as a predictor of incident colorectal neoplasia: longitudinal follow-up of a Taiwanese population-based colorectal cancer screening cohortThe Lancet Oncology, 2011
- Sensitivity of immunochemical faecal occult blood testing for detecting left- vs right-sided colorectal neoplasiaBritish Journal of Cancer, 2011
- Higher Fecal Immunochemical Test Cutoff Levels: Lower Positivity Rates but Still Acceptable Detection Rates for Early-Stage Colorectal CancersCancer Epidemiology, Biomarkers & Prevention, 2011
- Cutoff value determines the performance of a semi-quantitative immunochemical faecal occult blood test in a colorectal cancer screening programmeBritish Journal of Cancer, 2009
- Comparison of a guaiac based and an immunochemical faecal occult blood test in screening for colorectal cancer in a general average risk populationGut, 2007