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Effect of Sex, Age, and Positivity Threshold on Fecal Immunochemical Test Accuracy: A Systematic Review and Meta-analysis.
性别、年龄和阳性阈值对粪便免疫化学检测准确性的影响: 系统综述和荟萃分析。
Advanced Neoplasia Colon Cancer Diagnostic Performance Fecal Occult Blood Test
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摘要

BACKGROUND & AIMS:Quantitative fecal immunochemical tests (FITs) for hemoglobin are commonly used for colorectal cancer (CRC) screening. We aimed to quantify the change in CRC and advanced adenoma detection and number of positive test results at different positivity thresholds and by sex and age.
METHODS:We searched MEDLINE and EMBASE, selecting articles of FIT for CRC detection in asymptomatic adults undergoing screening. We calculated sensitivity and specificity, as well as detected number of cancers, advanced adenomas, and positive test results at positivity thresholds ≤10 μg hemoglobin/g feces, 10 to ≤20 μg/g, 20 to ≤30 μg/g, and >30 μg/g. We also analyzed results from stratified by patient sex, age, and reference standard.
RESULTS:Our meta-analysis comprised 46 studies with 2.4 million participants and 6478 detected cancers. Sensitivity for detection of CRC increased from 69% (95% confidence interval [CI], 63%-75%) at thresholds >10 μg/g and ≤20 μg/g to 80% (95% CI, 76%-83%) at thresholds ≤10 μg/g. At these threshold values, sensitivity for detection of advanced adenomas increased from 21% (95% CI, 18%-25%) to 31% (95% CI, 27%-35%), whereas specificity decreased from 94% (95% CI, 93%-96%) to 91% (95% CI, 89%-93%). In 3 studies stratified by sex, sensitivity of CRC detection was 77% in men (95% CI, 75%-79%) and 81% in women (95% CI, 60%-100%) (P = .68). In 3 studies stratified by age groups, sensitivity of CRC detection was 85% for ages 50-59 years (95% CI, 71%-99%) and 73% for ages 60-69 years (95% CI, 71%-75%) (P = .10). All studies with colonoscopy follow-up had similar sensitivity levels for detection of CRC to studies that analyzed 2-year registry follow-up data (74%; 95% CI, 68%-78% vs 75%; 95% CI, 73%-77%).
CONCLUSIONS:In a meta-analysis of studies that analyzed detection of CRC and advanced adenomas at different FIT positivity thresholds, we found the sensitivity and specificity of detection to vary with positive cutoff value. It might be possible to decrease positive threshold values for centers with sufficient follow-up colonoscopy resources. More research is needed to precisely establish FIT thresholds for each sex and age subgroup.
PROTOCOL:PROSPERO CRD42017068760.

译文

背景与目的: 血红蛋白定量粪便免疫化学试验 (FITs) 通常用于结直肠癌 (CRC) 筛查。我们旨在通过性别和年龄来量化不同阳性阈值下结直肠癌和晚期腺瘤检测的变化以及阳性检测结果的数量。
方法: 我们搜索 MEDLINE 和 EMBASE,在接受筛查的无症状成年人中选择适合 CRC 检测的文章。我们计算了敏感性和特异性,以及在阳性阈值 ≤ 10 μ g 血红蛋白/g 粪便,10 到 ≤ 20 μ g/g 时检测到的癌症、晚期腺瘤和阳性检测结果的数量, 20 至 ≤ 30 μ g/g,和> 30 μ g/g。我们还分析了按患者性别、年龄和参考标准分层的结果。
结果: 我们的荟萃分析包括 46 项研究,有 240万名参与者,6478 名检测到癌症。当阈值> 10 μ g/g 且 ≤ 20 μ g/g 时,检测 CRC 的灵敏度从 69% (95% 置信区间 [CI],63%-75%) 提高到 80% (95% CI, 76%-83%) 在阈值 ≤ 10 μ g/g。在这些阈值下,检测晚期腺瘤的灵敏度从 21% (95% CI,18%-25%) 提高到 31% (95% CI,27%-35%), 而特异性从 94% (95% CI,93%-96%) 下降到 91% (95% CI,89%-93%)。在 3 项按性别分层的研究中,男性的 CRC 检测灵敏度为 77% (95% 置信区间,75%-79%),女性为 81% (95% 置信区间,60%-100%) (P =。 68)。在 3 项按年龄组分层的研究中,50-59 岁的儿童检测 CRC 的灵敏度为 85% (95% CI,71%-99%),60-69 岁的儿童为 73% (95% CI, 71%-75%) (P =。 10)。与分析 2 年登记随访数据的研究 (74%; 95% CI,68%-78% vs 75%; 95% CI,73%-77%)。
结论: 在分析不同匹配阳性阈值下的 CRC 和晚期腺瘤检测的研究的荟萃分析中,我们发现检测的灵敏度和特异性随着阳性截断值而变化。有可能降低有足够随访结肠镜资源的中心的阳性阈值。需要更多的研究来精确地为每个性别和年龄分组建立合适的阈值。
协议: 普洛斯彼罗 crd42017068760。

fecal immunochemical test

肿瘤 结肠癌 诊断方式
概述  :  

粪便免疫化学测试(FIT)是一种早期结肠癌筛查程序,能够准确的检测粪便中是否出血,而这通常是癌症的一个早期征象,如果检测结果为阴性,那么患者不再需要进行结肠镜检查。而且患者可以保留隐私,在家中采集样品。FIT结肠癌筛查参与者可以寄送粪便样本至检测中心,然后接收FIT筛查结果。粪便免疫化学试验,由美国预防服务工作组认可,在美国成为越来越普遍的大肠癌筛查方法。有研究结果显示,粪便免疫化学试验阳性后,与那些在一个月内即接受随访结肠镜检查的患者相比,等待10个多月后才接受结肠镜检查的患者结直肠癌(C


Fecal   英 /'fiːkəl/   美 /'fikəl/

释    义   adj. 排泄物的;残渣的;糟粕的

例    句   Fecal Occult Blood test Every year to detect hidden blood in the stool, a possible sign of colon cancer. 粪便潜血检验每年一次,以检查粪便中是否潜血,粪便潜血是结肠癌的可能徵兆。

 

Immunochemical   英 /,ɪmjʊnəʊ'kemɪkəl/

释    义   adj. 免疫化学的

同根词   immune adj. 免疫的;免于……的,免除的

               immunized adj. 免疫的

               immunocompetent adj. 免疫活性的

               immunogenic adj. 产生免疫性的;

               immune n.免疫者;免除者

               immunity n. 免疫力;豁免权;免除

               immunization n. 免疫

               immunodeficiency n. [免疫] 免疫缺陷

               immunisation n. 免疫;免疫法

               immunoglobulin n. [免疫][生化] 免疫球蛋白;免疫血球素

               immunoassay n. 免疫分析,免疫测定

               immunochemistry n. 免疫化学

               immunocompetence n. 免疫能力;免疫活性

               immunoelectrophoresis n. [临床] 免疫电泳

               immunofluorescence n. [免疫] 免疫荧光;萤光免疫检验法

               immunogen n. [免疫] 免疫原

               immunogenicity n. [免疫] 免疫原性;致免疫性;致免疫力;

例    句   Conclusion: The condition of children with HLH can be effectively control early with immunochemical therapy of HLH-04 protocol. 结论:儿童HLH可通过采用HLH-04方案的免疫化学治疗,早期得以有效控制。

 

Test   英 /test/

释    义   n. 测验,考查;测试;检验;化验;v. 测验;化验,检查;试验,测试;考验

例    句   Why do we have to do durability test? 我们为什么要做耐久性测试?

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