背景:使用粪便免疫化学试验(FIT)对疑似结直肠癌(CRC)引起的缺铁(ID)患者进行结肠镜检查可能会改善结肠镜资源的分布。我们回顾了FIT在检测晚期结直肠肿瘤中的诊断性能,包括CRC和晚期癌前肿瘤(APCN),在有ID的患者中,有或没有贫血。
方法:我们对三个数据库的研究进行了系统评价,包括ID患者,有或没有贫血,在结肠镜检查前六个月内完成定量FIT,其中测试性能与参考标准结肠镜检查进行了比较。随机效应荟萃分析确定了FIT对晚期结直肠肿瘤的诊断性能。
结果:纳入了9项研究,共涉及n=1,761例ID患者,报告FIT阳性阈值在4-150µg血红蛋白/g粪便之间。只有一项研究包括非贫血ID(NAID)队列。FIT检测ID患者CRC和APCN的敏感性分别为90.7%和49.3%,和81.0%和82.4%的特异性,分别。在FIT阳性阈值为10µg血红蛋白/g粪便时,ID贫血患者的FIT敏感性为88.0%,特异性为83.4%。
结论:FIT对晚期结直肠肿瘤显示出很高的敏感性,可用于鉴别那些患有ID贫血的患者,其中结肠镜检查资源有限,使CRC高危人群优先接受结肠镜检查.需要进一步研究FIT在NAID患者中的诊断性能。
BACKGROUND: Use of the faecal immunochemical test (FIT) to triage patients with iron deficiency (ID) for colonoscopy due to suspected colorectal cancer (CRC) may improve distribution of colonoscopic resources. We reviewed the diagnostic performance of FIT for detecting advanced colorectal neoplasia, including CRC and advanced pre-cancerous neoplasia (APCN), in patients with ID, with or without anaemia.
METHODS: We performed a systematic review of three databases for studies comprising of patients with ID, with or without anaemia, completing a quantitative FIT within six months prior to colonoscopy, where test performance was compared against the reference standard colonoscopy. Random effects meta-analyses determined the diagnostic performance of FIT for advanced colorectal neoplasia.
RESULTS: Nine studies were included on a total of n=1761 patients with ID, reporting FIT positivity thresholds between 4-150 µg haemoglobin/g faeces. Only one study included a non-anaemic ID (NAID) cohort. FIT detected CRC and APCN in ID patients with 90.7 % and 49.3 % sensitivity, and 81.0 % and 82.4 % specificity, respectively. FIT was 88.0 % sensitive and 83.4 % specific for CRC in patients with ID anaemia at a FIT positivity threshold of 10 µg haemoglobin/g faeces.
CONCLUSIONS: FIT shows high sensitivity for advanced colorectal neoplasia and may be used to triage those with ID anaemia where colonoscopic resources are limited, enabling those at higher risk of CRC to be prioritised for colonoscopy. There is a need for further research investigating the diagnostic performance of FIT in NAID patients.