RESUMEN
AIM: The diagnostic accuracy of the faecal immunochemical test (FIT) at a 100 ng/ml threshold for colorectal cancer (CRC) was compared with National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) referral criteria. METHOD: A multicentre, prospective, blind study of diagnostic tests was carried out in two Spanish health areas. In 787 symptomatic patients referred for a diagnostic colonoscopy, we determined whether patients met NICE and SIGN referral criteria. All patients performed one FIT determination (OCsensor(™) ). The sensitivity and specificity for CRC detection were determined with McNemar's test. The diagnostic odds ratio as well as the number needed to scope (NNS) to detect a CRC were calculated. RESULTS: We detected CRC in 97 (12.3%) patients; 241 (30.6%) had an FIT ≥ 100 ng/ml and 300 (38.1%) and 473 (60.1%) met NICE and SIGN referral criteria. The FIT had a higher sensitivity for CRC detection than NICE criteria (87.6%, 61.9%; P < 0.001) and SIGN criteria (82.5%; P = 0.4). The specificity of FIT was also higher than NICE and SIGN criteria (77.4%, 65.2%, 42.7%; P < 0.001). The odds ratios of FIT, NICE and SIGN criteria for the diagnosis of CRC were 24.24 (95% CI 12.91-45.53), 3.04 (95% CI 1.96-4.71) and 3.51 (95% CI 2.03-6.06). The NNS to detect a CRC in individuals with an FIT ≥ 100 ng/ml was 2.83 (95% CI 2.4-3.41) and in individuals who met NICE and SIGN criteria it was 5 (95% CI 3.98-6.37) and 5.95 (95% CI 4.85-7.35). CONCLUSION: Our study suggests that FIT is more accurate for the detection of CRC than the current NICE and SIGN referral criteria in symptomatic patients referred for colonoscopy.
Asunto(s)
Biomarcadores de Tumor/análisis , Neoplasias Colorrectales/diagnóstico , Pruebas Diagnósticas de Rutina/métodos , Heces/química , Adulto , Anciano , Anciano de 80 o más Años , Colonoscopía , Detección Precoz del Cáncer , Femenino , Humanos , Inmunoquímica , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Valor Predictivo de las Pruebas , Estudios Prospectivos , Derivación y Consulta , Sensibilidad y Especificidad , Método Simple Ciego , EspañaRESUMEN
The iliocostalis lumborum, longissimus thoracis and spinalis thoracis muscles were studied electromyographically in six male individuals between 18 and 23 years old. They were connected to co-axial needle electrodes while in orthostatic, kneeling and sitting positions performing movements of flexing, extending and rotating the trunk. In the total flexing of the trunk the muscles did not present any action potential. The results showed intense potential for action while flexing the trunk 45 degrees, extending the trunk beginning at 45 degrees of flexing and in homolateral rotation for the muscles analyzed in the orthostatic position, emphasizing the iliocostalis lumborum muscle in the extension of the trunk which registered very strong action potentials in all individuals. There were similar results for movements of flexing and extending the trunk in the kneeling position, emphasizing the longissimus thoracis muscle in the movement of hyperextension. In the sitting position the more intense potentials were for the movements of extension, flexing with rotation and homolateral rotation of the trunk, emphasizing the longissimus thoracis muscle with strong potentials.