Brief Article
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World J Gastroenterol. Dec 7, 2013; 19(45): 8366-8372
Published online Dec 7, 2013. doi: 10.3748/wjg.v19.i45.8366
Application of quantitative estimates of fecal hemoglobin concentration for risk prediction of colorectal neoplasia
Chao-Sheng Liao, Yu-Min Lin, Hung-Chuen Chang, Yu-Hung Chen, Lee-Won Chong, Chun-Hao Chen, Yueh-Shih Lin, Kuo-Ching Yang, Chia-Hui Shih
Chao-Sheng Liao, Yu-Min Lin, Hung-Chuen Chang, Lee-Won Chong, Chun-Hao Chen, Kuo-Ching Yang, Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
Yu-Hung Chen, Department of Family Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
Yueh-Shih Lin, Health Management Center, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
Chao-Sheng Liao, Yu-Min Lin, School of Medicine, Fu Jen Catholic University, New Taipei City 24205, Taiwan
Chia-Hui Shih, Chang Gung Institute of Technology, School of Nursing, Tao-Yuan 333, Taiwan
Author contributions: Liao CS and Lin YM designed the study and wrote the manuscript; Chang HC, Chen YH, Chong LW and Chen CH acquired and collected the data; Lin YS and Shih CH analyzed the data; Yang KC revised the manuscript; all authors have read and approved the final version to be published.
Correspondence to: Yu-Min Lin, MD, Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih Lin District, Taipei 111, Taiwan. M001063@ms.skh.org.tw
Telephone: +886-2-28332211-2031 Fax: +886-2-28389335
Received: June 30, 2013
Revised: August 15, 2013
Accepted: August 28, 2013
Published online: December 7, 2013
Abstract

AIM: To determine the role of the fecal immunochemical test (FIT), used to evaluate fecal hemoglobin concentration, in the prediction of histological grade and risk of colorectal tumors.

METHODS: We enrolled 17881 individuals who attended the two-step colorectal cancer screening program in a single hospital between January 2010 and October 2011. Colonoscopy was recommended to the participants with an FIT of ≥ 12 ngHb/mL buffer. We classified colorectal lesions as cancer (C), advanced adenoma (AA), adenoma (A), and others (O) by their colonoscopic and histological findings. Multiple linear regression analysis adjusted for age and gender was used to determine the association between the FIT results and colorectal tumor grade. The risk of adenomatous neoplasia was estimated by calculating the positive predictive values for different FIT concentrations.

RESULTS: The positive rate of the FIT was 10.9% (1948/17881). The attendance rate for colonoscopy was 63.1% (1229/1948). The number of false positive results was 23. Of these 1229 cases, the numbers of O, A, AA, and C were 759, 221, 201, and 48, respectively. Regression analysis revealed a positive association between histological grade and FIT concentration (β = 0.088, P < 0.01). A significant log-linear relationship was found between the concentration and positive predictive value of the FIT for predicting colorectal tumors (R2 > 0.95, P < 0.001).

CONCLUSION: Higher FIT concentrations are associated with more advanced histological grades. Risk prediction for colorectal neoplasia based on individual FIT concentrations is significant and may help to improve the performance of screening programs.

Keywords: Colorectal cancer, Fecal immunochemical test, Screening, Risk prediction, Performance

Core tip: The fecal immunochemical test (FIT) for hemoglobin is specific for detecting colorectal lesions. With adjustment for age and gender of 17 881 attendees at a colorectal cancer screening program in a single hospital, we demonstrated that higher FIT concentrations were associated with more advanced histological grades (β = 0.088, P < 0.01). A significant log-linear relationship was found between the FIT concentration and positive predictive value of the FIT for predicting colorectal tumors (R2 > 0.95, P < 0.001). Risk stratification for colorectal neoplasia based on individual FIT concentration may help to improve the performance of screening programs.