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Comparative Study
. 2011 May 24;104(11):1779-85.
doi: 10.1038/bjc.2011.160. Epub 2011 May 10.

Sensitivity of immunochemical faecal occult blood testing for detecting left- vs right-sided colorectal neoplasia

U Haug  1 , K M Kuntz, A B Knudsen, S Hundt, H Brenner
Affiliations
Comparative Study

Sensitivity of immunochemical faecal occult blood testing for detecting left- vs right-sided colorectal neoplasia

U Haug et al. Br J Cancer. .

Abstract

Background: Faecal occult blood tests (FOBTs) are used for colorectal cancer (CRC) screening. We aimed to assess the sensitivity of an immunochemical FOBT for detecting advanced colorectal neoplasia in the left vs the right colon and to explore reasons for potential differences in site-specific test performance.

Methods: We prospectively measured faecal occult blood levels by a quantitative immunochemical FOBT (RIDASCREEN) in 2310 average-risk subjects undergoing screening colonoscopy. We compared diagnostic performance for subjects with left- vs right-sided advanced neoplasia, as well as patient characteristics and adenoma characteristics that have been suggested to impact faecal haemoglobin levels.

Results: Sensitivities for subjects with left- vs right-sided advanced neoplasia were 33% (95% confidence interval (CI), 26-41%) and 20% (CI, 11-31%) (P=0.04) at a specificity of 95% (overall sensitivity: 29%) and the areas under the receiver-operating characteristics curve were 0.71 (CI, 0.69-0.72) and 0.60 (CI, 0.58-0.63), respectively. Pedunculated shape was strikingly more common in participants with left- vs right-sided advanced neoplasia (47% vs 14%). In logistic regression analyses adjusted for site, pedunculated shape was statistically significantly associated with test sensitivity (P=0.04).

Conclusions: The immunochemical FOBT in our study was more sensitive for detecting subjects with left- vs right-sided advanced colorectal neoplasia. Our findings may stimulate further diagnostic research in the field as well as modelling analyses to estimate the potential effect of site-specific test performance on the effectiveness of annual or biennial FOBT-based screening programmes, in particular with respect to protection from right-sided CRC.

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Figures

Figure 1
Figure 1
Standards for reporting of diagnostic accuracy (STARD) flow diagram.
Figure 2
Figure 2
ROC curves for detecting patients with advanced colorectal neoplasia stratified by anatomical subsite, using a quantitative immunochemical FOBT. (In an ROC curve, the true positive rate (sensitivity) is plotted in function of the false positive rate (100−specificity) for different positivity thresholds (i.e., different cutoff levels) of a quantitative test (here, faecal haemoglobin levels). The AUC is a measure of how well a quantitative test can distinguish between subjects with and without a disease.)
Figure 3
Figure 3
ROC curves for detecting patients with one advanced colorectal neoplasm (and no other colorectal adenomas) stratified by anatomical subsite, using a quantitative immunochemical FOBT. (In an ROC curve, the true positive rate (sensitivity) is plotted in function of the false positive rate (100−specificity) for different positivity thresholds (i.e., different cutoff levels) of a quantitative test (here, faecal haemoglobin levels). The AUC is a measure of how well a quantitative test can distinguish between subjects with and without a disease.)
See this image and copyright information in PMC

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