| Theme | Clinical characteristics of fecal immunochemical test (FIT) negative colorectal cancer | |
|---|---|---|
| Title | Stage- and site-specific sensitivity of the fecal immunochemical test for advanced colorectal neoplasia -- A prospective study | |
| Publish Date | 2019/09 | |
| Author | Takahisa Matsuda | Cancer Screening Center, National Cancer Center Hospital / Endoscopy Division, National Cancer Center Hospital / Division of Screening Technology, Center for Public Health Sciences, National Cancer Center |
| Author | Hiroaki Ikematsu | Department of Gastroenterology and Endoscopy, National Cancer Hospital East |
| Author | Hiroyuki Takamaru | Endoscopy Division, National Cancer Center Hospital |
| Author | Yasuhiro Oono | Department of Gastroenterology and Endoscopy, National Cancer Hospital East |
| Author | Yasuhiko Mizuguchi | Endoscopy Division, National Cancer Center Hospital |
| Author | Masau Sekiguchi | Cancer Screening Center, National Cancer Center Hospital / Endoscopy Division, National Cancer Center Hospital / Division of Screening Technology, Center for Public Health Sciences, National Cancer Center |
| Author | Masayoshi Yamada | Endoscopy Division, National Cancer Center Hospital |
| Author | Taku Sakamoto | Endoscopy Division, National Cancer Center Hospital |
| Author | Yutaka Saito | Endoscopy Division, National Cancer Center Hospital |
| [ Summary ] | The fecal immunochemical test (FIT) is widely used in population-based colorectal cancer screening programs; however, the stage- and anatomical site-specific sensitivity of FIT for advanced colorectal neoplasia remains unclear. This study investigated the stage- and site-specific sensitivity of FIT for advanced adenomas and cancers at different stages. Patients with known advanced neoplasia (adenoma or cancer) who were scheduled to undergo endoscopic resection or surgery were prospectively enrolled. Quantitative FIT testing (OC-sensor system, Eiken Chemical) was performed using 100 ng hemoglobin/mL buffer as a cutoff value (equivalent to 20 μg hemoglobin/g feces), and all patients submitted 2 fecal samples for testing before undergoing therapeutic intervention. We calculated the sensitivity of FIT for large advanced adenomas and various stages of colorectal cancers. Additionally, we compared the sensitivity with regard to stage and anatomical site (proximal vs. distal). We prospectively enrolled 264 patients (mean age 64.1 years, 133 men [50.4 %]) with advanced neoplasia. Of these, 222 showed cancerous lesions [Tis:70, T1:50, and T2-4:102]. The sensitivity of FIT for advanced adenoma, Tis, T1, and T2-4 cancers was 35.7 %, 57.1 %, 74.0 %, and 92.2 %, respectively. The sensitivity of FIT was significantly lower for proximally located lesions than for distally located lesions in cases of advanced adenomas (16.7 % vs. 50.0 %, respectively, P=0.049), cancers (69.6 % vs. 82.3 %, respectively, P=0.035), and invasive cancers (74.5 % vs. 92.1 %, respectively, P=0.005). Based on these results, it is necessary to outline a strategy to incorporate total colonoscopy into FIT-based screening in Japan. | |