Diagnostic Performance of Fecal Immunochemical Test and Sigmoidoscopy for Advanced Right-Sided Colorectal Neoplasms

• Published in: Digestive diseases and sciences Vol. 60; no. 5; pp. 1424 - 1432
• Main Authors: Castro, Inés, Estevez, Pamela, Cubiella, Joaquín, Hernandez, Vicent, González-Mao, Carmen, Rivera, Concepción, Iglesias, Felipe, Cid, Lucía, Soto, Santiago, de-Castro, Luisa, Vega, Pablo, Hermo, Jose Antonio, Macenlle, Ramiro, Martínez, Alfonso, Cid, Estela, Gil, Inés, Larzabal, Mikel, Bujanda, Luis, Castells, Antoni
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-05-2015; Springer; Springer Nature B.V
• Subjects: Aged; Biochemistry; Cancer; Colorectal cancer; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - immunology; Colorectal Neoplasms - pathology; Comparative analysis; Cross-Sectional Studies; Diagnosis; Female; Gastroenterology; Hemoglobin; Hepatology; Humans; Immunohistochemistry; Male; Medicine; Medicine & Public Health; Middle Aged; Occult Blood; Oncology; Original Article; Predictive Value of Tests; Prevention; Prognosis; Referral and Consultation; Sigmoidoscopy; Spain; Transplant Surgery; Tumors; Spain; Colorectal cancer screening; Colorectal neoplasm; Fecal immunochemical test; Sigmoidoscopy; Colonoscopy
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-014-3434-6

Background
Colorectal cancer screening effect on right-sided colorectal neoplasia is limited. We compared fecal immunochemical test and simulated sigmoidoscopy diagnostic accuracy for advanced right-sided neoplasia detection.
Methods
We analyzed 1,292 individuals with complete screening colonoscopy with a fecal immunochemical test determination before colonoscopy. Sigmoidoscopy and “hybrid strategy” (sigmoidoscopy or fecal hemoglobin concentration ≥20 µg hemoglobin/g) diagnostic yield were simulated according to UK Flexible Sigmoidoscopy, Screening for COlon REctum (SCORE), and Norwegian Colorectal Cancer Prevention (NORCCAP) trials criteria to complete colonic examination. We compared sensitivity and specificity of both strategies and of “hybrid strategy” for advanced right-sided neoplasia with McNemar test.
Results
An advanced right-sided neoplasia was detected in 47 (3.6 %) subjects. A fecal hemoglobin concentration ≥20 µg hemoglobin/g was determined in 6.6 % of the subjects and 10.1, 12.7, and 23.5 % met UK, SCORE, and NORCCAP criteria, respectively. Fecal immunochemical test was statistically more specific than sigmoidoscopy strategies (93.8 %, UK 90.3 %, SCORE 87.7 %, NORCCAP 77.8 %;
p
 < 0.001). In contrast, fecal immunochemical test sensitivity for advanced right-sided neoplasia (17 %) was not statistically different than UK (21.3 %;
p
 = 0.7) or SCORE (23.4 %;
p
 = 0.5), although it was inferior than NORCCAP strategy (42.5 %;
p
 < 0.001). Adding fecal immunochemical test to sigmoidoscopy increased number of positives (8.5–25.7 %), sensitivity (10–30 %), and significantly reduced advanced right-sided neoplasia specificity (
p
 < 0.001).
Conclusions
Fecal immunochemical test and sigmoidoscopy diagnostic yield for advanced right-sided neoplasia are low. Fecal immunochemical test is more specific than sigmoidoscopy but less sensitive than sigmoidoscopy according to NORCCAP criteria.