000095759 001__ 95759
000095759 005__ 20230914083301.0
000095759 0247_ $$2doi$$a10.3389/fmed.2020.00410
000095759 0248_ $$2sideral$$a120196
000095759 037__ $$aART-2020-120196
000095759 041__ $$aeng
000095759 100__ $$aNavarro, M.
000095759 245__ $$aReducing the Cut-Off Value of the Fecal Immunochemical Test for Symptomatic Patients Does Not Improve Diagnostic Performance
000095759 260__ $$c2020
000095759 5060_ $$aAccess copy available to the general public$$fUnrestricted
000095759 5203_ $$aIntroduction: The fecal immunochemical test (FIT) has been established as a cost-effective test in colon cancer screening programmes. This test could also be helpful in symptomatic patients prior to colonoscopy, but data about diagnostic performance, and accurate cut-off values for these patients are still scarce.
Materials and Methods: Prospective study that included consecutive unselected patients with gastrointestinal symptoms referred for colonoscopy between November 2016 and June 2018. We performed a FIT (FOB Gold® test, cut-off 20 micrograms of Hb/gram of feces) prior to colonoscopy and determined the accuracy of FIT in terms of sensitivity, specificity, positive and negative predictive value for clinically significant pathology, advanced neoplasia, and colorectal cancer in symptomatic patients, using two different cut-off values.
Results: A total of 727 patients (44.3% men, aged 58.5 ± 14.9 years) was included in the study. The main symptom was history of previous (non-active) rectal bleeding (34.7%), followed by diarrhea (15.0%). Over one quarter of the patients (25.9%) had a positive FIT result. The caecal intubation rate was 95.5%. Clinically significant pathology was identified in 142 colonoscopies (19.5%), advanced neoplasia in 115 (15.8%) and colorectal cancer in 36 colonoscopies (5.0%). FIT performed very well for clinically significant pathology, advanced neoplasia and cancer, with a high negative predictive value (NPV). Reducing the cut-off value to 10 μg/g yielded similar NPV results, with a decrease in specificity. Using a combination of symptoms with a positive FIT result did not improve FIT performance. Only specificity was slightly higher compared to FIT alone, but this was paralleled by a decrease in sensitivity and NPV for cancer and clinically significant pathology. The odds of presenting clinically significant pathology, advanced neoplasia, or cancer increased with FIT concentration.
Conclusions: The specificity and NPV of FIT for clinically significant pathology, advanced neoplasia, and cancer are high in symptomatic patients. FIT is a helpful test for determining the need to perform further studies. It may not be necessary to reduce the cut-off value for symptomatic patients, since FIT performance with the current standard cut-off value used in colorectal cancer screening was accurate. FIT can be used to avoid or prioritize colonoscopy procedures.
000095759 536__ $$9info:eu-repo/grantAgreement/ES/ISCIII/CIBERehd
000095759 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/
000095759 590__ $$a5.091$$b2020
000095759 591__ $$aMEDICINE, GENERAL & INTERNAL$$b28 / 167 = 0.168$$c2020$$dQ1$$eT1
000095759 592__ $$a1.387$$b2020
000095759 593__ $$aMedicine (miscellaneous)$$c2020$$dQ1
000095759 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000095759 700__ $$aHijos, G.
000095759 700__ $$0(orcid)0000-0001-7466-3876$$aSostres, C.$$uUniversidad de Zaragoza
000095759 700__ $$aLué, A.
000095759 700__ $$0(orcid)0000-0002-7213-7095$$aPuente-Lanzarote, J.J.
000095759 700__ $$aCarrera-Lasfuentes, P.
000095759 700__ $$0(orcid)0000-0001-5932-2889$$aLanas, A.$$uUniversidad de Zaragoza
000095759 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina
000095759 773__ $$g7 (2020), 410 [9 pp]$$pFront. med.$$tFrontiers in Medicine$$x2296-858X
000095759 8564_ $$s215860$$uhttps://zaguan.unizar.es/record/95759/files/texto_completo.pdf$$yVersión publicada
000095759 8564_ $$s29304$$uhttps://zaguan.unizar.es/record/95759/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
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000095759 951__ $$a2023-09-13-10:53:21
000095759 980__ $$aARTICLE