PDF(Pubmed)
Abstract：
In patients with iron deficiency anaemia (IDA), the diagnostic yield of gastroscopy and colonoscopy (bidirectional endoscopy) in detecting neoplastic lesions is low. This study aimed to develop and validate a faecal immunochemical test (FIT)-based model to optimise the work-up of patients with IDA.
Outpatients with IDA were enrolled in a prospective, multicentre study from April 2016 to October 2019. One FIT was performed before bidirectional endoscopy. Significant gastrointestinal lesions were recorded and a combined model developed with variables that were independently associated with significant colorectal lesions in the multivariate analysis. The model cut-off was selected to provide a sensitivity of at least 95% for colorectal cancer (CRC) detection, and its performance was compared to different FIT cut-offs. The data set was randomly split into two groups (developed and validation cohorts). An online calculator was developed for clinical application.
The development and validation cohorts included 373 and 160 patients, respectively. The developed model included FIT value, age, and sex. In the development and validation cohorts, a model cut-off of 0.1375 provided a negative predictive value of 98.1 and 96.7% for CRC and 90.7 and 88.3% for significant colorectal lesions, respectively. This combined model reduced the rate of missed significant colorectal lesions compared to FIT alone and could have avoided more than one-fourth of colonoscopies.
The FIT-based combined model developed in this study may serve as a useful diagnostic tool to triage IDA patients for early endoscopic referral, resulting in considerable reduction of unnecessary colonoscopies.
Outpatients with IDA were enrolled in a prospective, multicentre study from April 2016 to October 2019. One FIT was performed before bidirectional endoscopy. Significant gastrointestinal lesions were recorded and a combined model developed with variables that were independently associated with significant colorectal lesions in the multivariate analysis. The model cut-off was selected to provide a sensitivity of at least 95% for colorectal cancer (CRC) detection, and its performance was compared to different FIT cut-offs. The data set was randomly split into two groups (developed and validation cohorts). An online calculator was developed for clinical application.
The development and validation cohorts included 373 and 160 patients, respectively. The developed model included FIT value, age, and sex. In the development and validation cohorts, a model cut-off of 0.1375 provided a negative predictive value of 98.1 and 96.7% for CRC and 90.7 and 88.3% for significant colorectal lesions, respectively. This combined model reduced the rate of missed significant colorectal lesions compared to FIT alone and could have avoided more than one-fourth of colonoscopies.
The FIT-based combined model developed in this study may serve as a useful diagnostic tool to triage IDA patients for early endoscopic referral, resulting in considerable reduction of unnecessary colonoscopies.
摘要：
■缺铁性贫血（IDA）患者，胃镜和结肠镜检查（双向内窥镜检查）在检测肿瘤性病变方面的诊断率较低。这项研究旨在开发和验证基于粪便免疫化学测试（FIT）的模型，以优化IDA患者的工作。
■患有IDA的门诊患者被纳入前瞻性，2016年4月至2019年10月的多中心研究。双向内窥镜检查前进行一次FIT。记录明显的胃肠道病变，并使用多变量分析中与明显的结直肠病变独立相关的变量开发组合模型。选择模型截止值以提供对结直肠癌（CRC）检测的至少95％的灵敏度。并将其性能与不同的FIT截止值进行了比较。将数据集随机分成两组(开发和验证队列)。开发了一种用于临床应用的在线计算器。
■开发和验证队列包括373和160名患者，分别。开发的模型包括FIT值，年龄,和性爱。在开发和验证队列中，0.1375的模型截止值对CRC提供了98.1和96.7%的阴性预测值，对显著的结直肠病变提供了90.7和88.3%的阴性预测值，分别。与单独使用FIT相比，该组合模型降低了明显的结直肠病变的漏诊率，并且可以避免超过四分之一的结肠镜检查。
■本研究中开发的基于FIT的组合模型可以作为一种有用的诊断工具，用于对IDA患者进行早期内镜转诊。导致不必要的结肠镜检查大大减少。
■患有IDA的门诊患者被纳入前瞻性，2016年4月至2019年10月的多中心研究。双向内窥镜检查前进行一次FIT。记录明显的胃肠道病变，并使用多变量分析中与明显的结直肠病变独立相关的变量开发组合模型。选择模型截止值以提供对结直肠癌（CRC）检测的至少95％的灵敏度。并将其性能与不同的FIT截止值进行了比较。将数据集随机分成两组(开发和验证队列)。开发了一种用于临床应用的在线计算器。
■开发和验证队列包括373和160名患者，分别。开发的模型包括FIT值，年龄,和性爱。在开发和验证队列中，0.1375的模型截止值对CRC提供了98.1和96.7%的阴性预测值，对显著的结直肠病变提供了90.7和88.3%的阴性预测值，分别。与单独使用FIT相比，该组合模型降低了明显的结直肠病变的漏诊率，并且可以避免超过四分之一的结肠镜检查。
■本研究中开发的基于FIT的组合模型可以作为一种有用的诊断工具，用于对IDA患者进行早期内镜转诊。导致不必要的结肠镜检查大大减少。
