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Open Access Research article

Faecal immunochemical test accuracy in patients referred for surveillance colonoscopy: a multi-centre cohort study

Jochim S Terhaar sive Droste19*, Sietze T van Turenhout1, Frank A Oort1, René WM van der Hulst2, Vincent A Steeman1, Usha Coblijn1, Lisette van der Eem1, Ruud Duijkers1, Anneke A Bouman3, Gerrit A Meijer4, Annekatrien CTM Depla5, Pieter Scholten6, Ruud JLF Loffeld7, Veerle MH Coupé8 and Chris JJ Mulder1

Author Affiliations

1 Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands

2 Gastroenterology and Hepatology, Kennemer Gasthuis, Haarlem, The Netherlands

3 Clinical Chemistry, VU University Medical Centre, Amsterdam, The Netherlands

4 Pathology, VU University Medical Centre, Amsterdam, The Netherlands

5 Gastroenterology and Hepatology, Slotervaart Hospital, Amsterdam, The Netherlands

6 Gastroenterology and Hepatology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands

7 Internal Medicine, Zaans Medical Centre, Zaandam, The Netherlands

8 Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands

9 Department of Gastroenterology and Hepatology, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands

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BMC Gastroenterology 2012, 12:94  doi:10.1186/1471-230X-12-94

Published: 24 July 2012

Abstract

Background

Given the increasing burden on colonoscopy capacity, it has been suggested that faecal immunochemical test (FIT) results could guide surveillance colonoscopy intervals. Against this background, we have evaluated the test accuracy of single and double FIT sampling to detect colorectal cancer (CRC) and/or advanced adenomas in an asymptomatic colonoscopy-controlled high-risk population.

Methods

Cohort study of asymptomatic high-risk patients (personal history of adenomas/CRC or family history of CRC), who provided one or two FITs before elective colonoscopy. Test accuracy of FIT for detection of CRC and advanced adenomas was determined (cut-off level 50 ng/ml).

Results

1,041 patients provided a FIT (516 personal history of adenomas, 172 personal history of CRC and 353 family history of CRC). Five CRCs (0.5%) and 101 advanced adenomas (9.7%) were detected by colonoscopy. Single FIT sampling resulted in a sensitivity, specificity, PPV and NPV for CRC of 80%, 89%, 3% and 99.9%, respectively, and for advanced adenoma of 28%, 91%, 24% and 92%, respectively. Double FIT sampling did not result in a significantly higher sensitivity for advanced neoplasia. Simulation of multiple screening rounds indicated that sensitivity of FIT for advanced adenoma could reach 81% after 5 screening rounds.

Conclusions

In once-only FIT sampling before surveillance colonoscopy, 70% of advanced neoplasia were missed. A simulation approach indicates that multiple screening rounds may be more promising in detecting advanced neoplasia and could potentially alleviate endoscopic burden.

Keywords:
Colorectal cancer; Faecal immunochemical test (FIT); Surveillance; Advanced adenoma; Sensitivity