Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 14, 2012; 18(30): 4004-4011
Published online Aug 14, 2012. doi: 10.3748/wjg.v18.i30.4004
Faecal pyruvate kinase isoenzyme type M2 for colorectal cancer screening: A meta-analysis
Carolin Tonus, Markus Sellinger, Konrad Koss, Gero Neupert
Carolin Tonus, Gero Neupert, Asklepios Hospital North, General and Visceral Surgery, 22417 Hamburg, Germany
Markus Sellinger, Medical Practice for Gastroenterology Lusanum, 67061 Ludwigshafen, Germany
Konrad Koss, Department of Gastroenterology, Macclesfield District General Hospital, Macclesfield, Cheshire SK10 3BL, United Kingdom
Author contributions: Tonus C and Neupert G conducted the literature review and wrote the article; Sellinger M and Koss K reviewed the text and made significant revisions to drafts of this manuscript.
Correspondence to: Dr. Carolin Tonus, Professor, Asklepios Hospital North, General and Visceral Surgery, Tangstedter Landstrasse 400, 22417 Hamburg, Germany.
Telephone: +49-40-1818873667 Fax: +49-40-1818873112
Received: August 4, 2011
Revised: November 26, 2011
Accepted: April 22, 2012
Published online: August 14, 2012

AIM: To present a critical discussion of the efficacy of the faecal pyruvate kinase isoenzyme type M2 (faecal M2-PK) test for colorectal cancer (CRC) screening based on the currently available studies.

METHODS: A literature search in PubMed and Embase was conducted using the following search terms: fecal Tumor M2-PK, faecal Tumour M2-PK, fecal M2-PK, faecal M2-PK, fecal pyruvate kinase, faecal pyruvate kinase, pyruvate kinase stool and M2-PK stool.

RESULTS: Stool samples from 704 patients with CRC and from 11 412 healthy subjects have been investigated for faecal M2-PK concentrations in seventeen independent studies. The mean faecal M2-PK sensitivity was 80.3%; the specificity was 95.2%. Four studies compared faecal M2-PK head-to-head with guaiac-based faecal occult blood test (gFOBT). Faecal M2-PK demonstrated a sensitivity of 81.1%, whereas the gFOBT detected only 36.9% of the CRCs. Eight independent studies investigated the sensitivity of faecal M2-PK for adenoma (n = 554), with the following sensitivities: adenoma < 1 cm in diameter: 25%; adenoma > 1 cm: 44%; adenoma of unspecified diameter: 51%. In a direct comparison with gFOBT of adenoma > 1 cm in diameter, 47% tested positive with the faecal M2-PK test, whereas the gFOBT detected only 27%.

CONCLUSION: We recommend faecal M2-PK as a routine test for CRC screening. Faecal M2-PK closes a gap in clinical practice because it detects bleeding and non-bleeding tumors and adenoma with high sensitivity and specificity.

Keywords: Faecal pyruvate kinase isoenzyme type M2, Colorectal cancer screening, Colorectal cancer, Stool, Faecal occult blood, Adenoma, Polyps