Barreras y facilitadores del acceso al tamizaje de cáncer colorrectal / Barriers and facilitators of colorectal cancer screening access

Resumen Introducción : El cáncer colorrectal (CCR) es un pro blema de salud a nivel global. En el sector público de Bahía Blanca, el tamizaje de CCR es oportunista, por solicitud de sangre oculta en materia fecal (SOMF). El objetivo de este trabajo es describir el acceso al tamiza je de CCR de la población con cobertura pública exclu siva que reside en el área programática 2 de la ciudad entre 2019 y 2021, y relevar las barreras y facilitadores que lo determinan. Métodos : Se estimó la tasa de uso anual y acumula da de SOMF. Las barreras y facilitadores se relevaron a través de 41 entrevistas individuales semi-estructuradas al personal de salud del área programática, el Hospital Municipal, Secretaría de Salud y usuarios/no usuarios del sistema. Resultados : La tasa acumulada de uso de SOMF en el período fue 4.8%. Entre las barreras al tamizaje per cibidas se destacan: la dificultad en el acceso a estudios de mayor complejidad para pacientes con SOMF+, el desconocimiento y falta de percepción del CCR como un problema de salud por parte de la población y la baja adherencia de los profesionales a los lineamientos. La territorialidad y el vínculo de los centros de salud con la población, y la predisposición de usuarios y profesio nales a incorporar el tamizaje surgen como facilitadores del mismo. Conclusiones : El relevamiento de las barreras orien tará el diseño de estrategias adaptadas al contexto que permitan en el futuro reforzar el tamizaje.

Abstract Introduction : Colorectal cancer (CRC) is a global health problem. In the public sector of Bahía Blanca, CRC screening is opportunistic, through the request of fecal occult blood test (FOBT). The objective of this study is to describe access to CRC screening for the population with exclusive public coverage residing in the program matic area 2 of the city between 2019 and 2021, and to identify the barriers and facilitators that determine it. Methods : The annual and cumulative usage rate was estimated based on the number of patients who requested FOBT. The barriers and facilitators were studied through 41 semi-structured individual inter views to healthcare staff from the area, the Municipal Hospital, Health Secretariat and users/non-users of the system. Results : The cumulative usage rate of FOBT during the period was less than 5%. Among the perceived bar riers to screening, we found: the difficulties in accessing more complex studies for patients with positive FOBT, the lack of population awareness and perception of CRC as a health problem, the low adherence of professionals to guidelines. The territoriality and link of health centers with the population, as well as the willingness of users and professionals to incorporate screening, emerge as facilitators. Conclusion : The identification of barriers and facilita tors will allow the design of context-adapted strategies that will strengthen screening in the future.

Asymptomatic intestinal tuberculosis of the terminal ileum diagnosed on colonoscopy: a case report and literature review / Journal of Rural Medicine

Objective: Colonoscopy is useful in diagnosing intestinal tuberculosis. However, the terminal ileum is generally not examined during routine colonoscopy. Therefore, even with colonoscopy, the diagnosis can be missed in patients with lesions confined to the terminal ileum. Herein, we report the case of an asymptomatic patient with intestinal tuberculosis, in whom a colonoscope insertion into the terminal ileum led to the diagnosis.Patient: An asymptomatic 71-year-old man visited our hospital for a colonoscopy after a positive fecal occult blood test.Results: Colonoscopy revealed diffuse edematous and erosive mucosa in the terminal ileum. Mycobacterium tuberculosis was detected by polymerase chain reaction and culture of biopsy specimens from the erosions, leading to the diagnosis of intestinal tuberculosis. The patient was treated with antitubercular agents for 6 months, and a follow-up colonoscopy revealed healing of the lesions.Conclusion: Asymptomatic intestinal tuberculosis may occasionally be detected on colonoscopy following a positive fecal occult blood test and is sometimes confined to the terminal ileum. Therefore, clinicians should consider intestinal tuberculosis in the differential diagnosis of the causes of positive fecal occult blood test results and perform colonoscopies, including observation of the terminal ileum.

Connotation of distal bleeding based on modern pathophysiological mechanism and application of Huangtu Decoction for acute coronary syndrome complicated with acute upper gastrointestinal hemorrhage in critical care medicine / 中国中药杂志

Huangtu Decoction, first recorded in Essentials from the Golden Cabinet(Jin Kui Yao Lue) from ZHANG Zhong-jing in Han dynasty, is used to treat distal bleeding. It is mainly treated for the syndrome of failing to control blood with spleen-yang deficiency. The connotation of distal bleeding is more extensive, including not only upper gastrointestinal bleeding in the traditional sense such as peptic ulcer bleeding, gastrointestinal tumors, gastric mucosal lesions, vascular dysplasia, esophagogastric variceal bleeding, and pancreatic and biliary tract injury, but also other anorectal diseases such as part colon and rectal cancer swelling or polyps, hemorrhoids, and anal fissure and other parts of bleeding such as epistaxis, thrombocytopenia, functional uterine bleeding, threatened abortion, and unexplained hematuria. Distal bleeding also involves syndromes of failing to keep part deficient and cold fluids in interior, such as nocturia, enuresis, clear nose, sweating, cold tears, and leucorrhea, and excessive gastrointestinal bleeding caused by anti-plate and anticoagulant drugs, unexplained positive in the fecal occult blood test, and other modern clinical new problems. The indications of Huangtu Decoction include not only lower blood, defecation before blood, distant blood, hematemesis, epistaxis, and other diseases in traditional Chinese medicine, but also three types of clinical manifestations including bleeding, deficiency syndrome, and stagnant heat syndrome. In the clinic, Huangtu Decoction can be used to treat acute upper gastrointestinal bleeding, acute coronary syndrome complicated with acute upper gastrointestinal bleeding, bleeding events caused by excessive antiplatelet and anticoagulant drugs, unexplained positive in the fecal occult blood test, gastrointestinal tumor with bleeding, thrombocytopenia, and other acute and critical diseases. The dosage of Cooking Stove Earthkey, Rehmanniae Radix, and Asini Corii Colla in Huangtu Decoction is the key to hemostasis.

Research status of fecal detection for colorectal cancer markers / 国际肿瘤学杂志

There are four methods for fecal detection of colorectal cancer (CRC) markers: fecal occult blood test, fecal DNA test, fecal microRNA test, and fecal fusobacterium nucleatum (Fn) test. Fecal immunochemical test has been recommended by experts at home and abroad as the first choice for CRC screening. Fecal DNA test, due to its high price, has not yet been screened for large samples of people in China, so it is recommended as the second level of CRC screening. Fecal microRNA detection has been paid more and more attention by researchers. In recent years, the detection of fecal microbial markers has become more and more popular, especially fecal Fn detection, which is expected to become a microbial indicator for CRC screening.

Results of Colorectal Cancer Screening and Colonoscopic Compliance Among Community Residents in Zhuanqiao Town, Minhang District, Shanghai / 胃肠病学

Background: Colorectal cancer (CRC) is one of the most common malignancies in clinical practice. Its incidence and mortality rate are increasing in China in recent years. Aims: To analyze the results of CRC screening and the factors affecting the compliance of colonoscopy among community residents in Zhuanqiao Town, Minhang District, Shanghai. Methods: The community residents who were screened for CRC in Zhuanqiao Town from July 2020 to January 2021 were recruited. Both the risk assessment questionnaire and the fecal occult blood test (FOBT) were performed for the primary screening, and those who were positive for primary screening were recommended to undergo colonoscopy. High-risk individuals unwilling to undergo colonoscopy were surveyed for the reason of refusal. Results: During the study period, a total of 6 383 residents participated in the screening program, the positivity rates of risk assessment, FOBT and with either of them were 7.2% (459 cases), 10.5% (670 cases) and 17.2% (1 095 cases), respectively. Two hundred and ninety-seven residents who were positive for primary screening underwent a colonoscopy, with an overall colonoscopic compliance rate of 27.1%. The colonoscopic compliance rate in residents aged from 60-69 years was higher than that in other age groups (P<0.05). The detection rate of CRC was 2.0% (6/297). Insufficient knowledge of CRC and having no obvious physical discomfort were the main factors affecting colonoscopic compliance in high-risk population. Conclusions: Risk assessment combined with FOBT can identify high-risk population of CRC rapidly and efficiently. For the CRC screening program, education of the knowledge on CRC should be strengthened for improving the cognitive level of CRC in community residents. The screening program should be further optimized.

Estudio prospectivo acerca de la precisión diagnóstica del test inmunológico de sangre oculta en materia fecal en una única ronda para la realización de pesquisa del cáncer colorrectal en pacientes de riesgo promedio en la Argentina / Prospective study on the diagnostic accuracy of the immunochemical fecal occult blood test in a single round for colorectal cancer screening in average risk patients in Argentina

Introducción: El cáncer colorrectal (CCR) es la segunda causa de muerte por cáncer en Argentina. Debido a su alta prevalencia es fundamental normatizar un programa de pesquisa para la prevención y detección temprana. La precisión del test de sangre oculta en materia fecal inmunológico (SOMFi) para pesquisa de CCR en población de riesgo promedio ha demostrado ser adecuada según la bibliografía internacional, no habiendo, sin embargo, información a nivel local. El objetivo es evaluar en nuestro medio la precisión diagnóstica del test de SOMFi en una única ronda para la pesquisa de CCR en pacientes de riesgo promedio. Diseño: Prospectivo de precisión diagnóstica. Material y Método: Se incluyeron pacientes con riesgo promedio que consultaron para realizar una videocolonoscopía (VCC) por pesquisa de CCR en el Hospital Alemán de Buenos Aires, entre el 1 de junio del 2015 y 31 diciembre de 2017. Se excluyeron todos los pacientes con riesgo incrementado para CCR. Todos los pacientes realizaron el test de SOMFi y posteriormente la VCC. Los endoscopistas estaban ciegos para el resultado del test al momento de realizar la VCC. Se evaluó la precisión diagnóstica del test SOMFi para detectar lesiones neoplásicas avanzadas (LNA) calculando la sensibilidad (S), especificidad (E), valor predictivo positivo (VVP) y negativo (VVN), coeficiente de probabilidad positivo (CP+) y negativo (CP-). Se evaluó también la precisión para la detección de adenomas de bajo riesgo, pólipos aserrados y CCR. Resultados: Se incluyeron un total de 300 pacientes; 273 (91%) entregaron la muestra de materia fecal para realizar el test de SOMFi y completaron la VCC. La edad media de los pacientes fue de 56.9 (40-85) años y 54% fueron hombres. Del total de pacientes que realizaron ambos estudios (273), 53 pacientes (19%) presentaron al menos un adenoma de bajo riesgo, en 18 pacientes (6,59%) observamos al menos un adenoma aserrado sésil y en 21 pacientes (7,7%) al menos una lesión neoplásica avanzada (LNA). Solo 4 pacientes (1.5%) presentaron CCR. En cuanto a la precisión diagnóstica del test de SOMFi en una única ronda para detectar LNA observamos una S de 30%, E de 84%, VPP de 13% y un VPN de 94%. Para adenomas de bajo riesgo observamos una S de 13%, E de 84%, VPP de 17%, VPN de 79%. Para adenomas aserrados sésiles observamos una S de 16.7%, E de 87%, VPP de 11% y de VPN 91%. La precisión para el CCR fue la siguiente, S de 75%, E de 83%, VPP 6%, VPN 99%. No se observaron complicaciones post procedimientos. Conclusiones: La precisión diagnóstica del test de SOMFi en nuestro medio es comparable a los resultados internacionales. Sin embargo, la baja precisión observada en una única ronda realza la necesidad de realizarlo de forma anual o bianual para poder optimizar su precisión y lograr programas de pesquisa efectivos.(AU)

Background: Colorectal cancer (CRC) is the second leading cause of cancer death in Argentina. Due to its high prevalence, it is essential to standardize a screening program for prevention and early detection. According to international literature, the accuracy of the immunochemical fecal occult blood test (FIT) for CRC screening in an average-risk population has proven to be adequate, but there is no information at the local level. Objective: To evaluate the diagnostic accuracy of the FIT test in a single round for CRC screening in average-risk patients in our setting. Design: Diagnostic accuracy prospective study. Material and Methods: Average-risk patients who consulted for a CRC screening video colonoscopy (VCC) at the Hospital Alemán of Buenos Aires, between June 1, 2015 and December 31, 2017 were included. All patients with increased risk for CRC were excluded. All patients performed FIT and subsequently VCC. The endoscopists were blind to FIT result at the time of VCC. The diagnostic accuracy of FIT to detect advanced neoplastic lesions (ANL) was evaluated by calculating sensitivity (S), specificity (Sp), positive predictive value (PPV), negative (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-). The accuracy for the detection of low-risk adenomas, serrated polyps and CRC was also evaluated. Results: A total of 300 patients were included; 273 (91%) submitted the stool sample to perform FIT and completed VCC. The mean age of patients was 56.9 (40-85) years and 54% were men. Of the total number of patients who carried out both studies (273), 53 (19%) patients had at least one low-risk adenoma, 18 (6.59%) patients had at least one sessile serrated adenoma and 21 (7.7%) patients had at least one ANL. Only 4 (1.5%) patients presented CRC. The diagnostic accuracy of FIT in a single round to detect ANL was: S 30%, Sp 84%, PPV 13%, NPV 94%; for low-risk adenomas: S 13%, Sp 84%, PPV 17%, NPV 79%; for sessile serrated adenomas: S 16.7%, Sp 87%, PPV 11%, NPV 91% and for CRC: S 75%, Sp 83%, PPV 6%, NPV 99%. No post-procedure complications were observed. Conclusions: The diagnostic accuracy of FIT in our setting is comparable to international results. However, the low precision observed in a single round highlights the need to do it annually or biannually in order to optimize its accuracy and achieve effective screening programs. (AU)

Association of fecal occult blood tests results with colonoscopic findings in a general hospital and validation of the screening test / Achados colonoscópicos em pacientes submetidos a exame de sangue oculto nas fezes e validacão deste teste de triagem

ABSTRACT Globally, colorectal cancer is the third leading cause of cancer death among men and the second among women, corresponding to about 10% of all cancers. The Brazilian Ministry of Health and National Cancer Institute recommend the screening of colorectal cancer for people over 50 years-old with Fecal Occult Blood Test. Endoscopy is limited to patients with positive screening results. The aim of this study is to evaluate the incidence of malignant or premalignant lesions diagnosed by endoscopy in patients with positive or negative Fecal Occult Blood Test and assess the efficacy of Fecal Occult Blood Test to predict the finding of a malignant colorectal lesion. We carried out a cross-sectional study among patients with a Fecal Occult Blood Test result that were submitted to colonoscopy, in the same hospital, from March 2016 to July 2017. Sensitivity, specificity, positive and negative predictive value of Fecal Occult Blood Test compared to colonoscopy neoplastic findings was calculated. The total of 92 patients were enrolled, 52 (56.5%) were female, Fecal Occult Blood Test was positive in 42.4% of them and in 41 (44.6%) the colonoscopy showed abnormal findings. Polyps were the most frequent alteration, found in 20 patients (21.7%). Among the patients with polyps, 15 (16.3%) had neoplastic and 5 (5.4%) presented non-neoplastic polyps. The Fecal Occult Blood Test sensitivity for detection of neoplastic polyps was 66.7%, specificity 62.3%, positive predictive value 11% and negative predictive value was 94.2%. Considering the need for a screening method, Fecal Occult Blood Test showed to be an effective and reliable screening test that can be applied in public health programs to detect and prevent colorectal cancer.

RESUMO Globalmente, o carcinoma colorretal é a terceira principal causa de morte por neoplasia entre homens e a segunda entre mulheres, correspondendo a 10% de todas as neoplasias. O Ministério da Saúde Brasileiro e o Instituto Nacional do Câncer recomendam a triagem do câncer colorretal para indivíduos acima de 50 anos, utilizando a Pesquisa de Sangue Oculto nas fezes. A endoscopia é reservada para aqueles com Pesquisa de Sangue Oculto nas fezes positiva. O objetivo deste estudo é avaliar a incidência de lesões malignas/pré-malignas diagnósticas na colonoscopia e correlacionar com os resultados prévios da Pesquisa de Sangue Oculto e verificar a eficácia da Pesquisa de Sangue Oculto para predizer uma lesão colorretal maligna. Realizamos um estudo transversal em pacientes que apresentavam resultados positivos ou negativos de Pesquisa de Sangue Oculto nas fezes e foram submetidos à colonoscopia, na mesma instituição, entre março de 2016 e julho de 2017. Dos 92 participantes; 52 (56,5%) eram do sexo feminino, a Pesquisa de Sangue Oculto nas fezes foi positiva em 42,4%; e em 41 (44,6%) a colonoscopia mostrou alterações. Em 20 pacientes (21,7%) havia pólipos; 15 (16,3%) eram neoplásicos e 5 (5,4%) não neoplásicos. A sensibilidade da Pesquisa de Sangue Oculto nas fezes para detecção de pólipos neoplásicos foi 66,7%; a especificidade 62,3%; o valor preditivo positivo 11% e o valor preditivo negativo 94,2%. Considerando a necessidade de um método de triagem, a Pesquisa de Sangue Oculto nas fezes mostrou ser um exame de triagem eficaz e confiável para ser aplicado em programas de saúde pública com o objetivo de detectar e prevenir o carcinoma colorretal.

Application of urinary 5- aminolevulinic acid detection in screening and identification of colorectal cancer and adenomatous polyps / 中国医师进修杂志

Objective To study the application of urinary 5-aminolevulinic acid (5-ALA) detection in screening and identification of colorectal cancer and adenomatous polyps. Methods The clinical data of 500 high-risk patients(including 22 cases with colorectal cancer, 134 cases with adenomatous polyps, and 344 cases with other patients) at the First Affiliated Hospital of Hebei North University from January 2018 to October 2018 were collected. High performance liquid chromatography (HPLC) was used to detect urinary 5-ALA and fecal occult blood test was used to detect faeces. Sensitivity and specificity of two methods was compared. At the same time, urine samples of 431 cases (including 22 cases with colorectal cancer, 134 cases with adenomatous polyps and 275 cases with colorectal normal mucosa)were collected, and the difference of the content of urinary 5-ALA among three groups was compared. Results The sensitivity of urinary 5-ALA for the colorectal cancer screening was 74.9% , and the specificity was 72.5% . The sensitivity of urinary 5-ALA for the adenomatous polyps screening was 70.1% , and the specificity was75.0% . The sensitivity of fecal occult blood test for the colorectal cancer screening was 63.6% , and the specificity was 62.1% . The sensitivity of fecal occult blood test for the adenomatous polyps screening was 42.3%, and the specificity was 62.5%. The content of urinary 5-ALA of the colorectal cancer group [(9.35 ± 0.46) μmol/g] was significantly higher than that of the adenomatous polyps group [(7.24 ± 0.64) μmol/g] (P<0.05) and normal colorectal mucosa group [(3.12 ± 0.24) μmol/g] (P<0.05), and the content of urinary 5-ALA of the adenomatous polyps group was significantly higher than that of colorectal normal mucosa group (P<0.05). Conclusions For screening of colorectal cancer and adenomatous polyps, the content of urinary 5-ALA by HPLC is better than fecal occult blood test, and this approach can do great help to identify colorectal cancer, adenomatous polyps and normal colorectal mucosa.

The application of quantitative immune fecal occult blood test for the screening of colorectal cancer in health check?up participants / 中华健康管理学杂志

Objective To evaluate the application value of quantitative immune fecal occult blood test (FOBT) in colonoscopy for the screening of colorectal cancer in health check-up participants. Methods The subjects were selected from July 2017 to June 2018 in the Health Management Center of the Second Affiliated Hospital of Suzhou University. The subjects were the healthy individuals who chose quantitative immune FOBT or chemical method plus immunogold double-method FOBT (referred to as"double-method FOBT"), excluding those who had interfering factors. Individuals with a positive result in primary screening were selected and conducted with colorectal cancer by colonoscopy. If the polyploidy lesions were observed during colonoscopy, the biopsy or excision was performed, and the pathological diagnosis was performed. The positive rate of primary screening, compliance rate of colonoscopy and pathological results of colonoscopy were compared between the two methods. Quantitative immunoassay FOBT was analyzed in different gender, age group, physical examination nature, positive rate of primary screening, compliance rate of colonoscopy and pathological results of colonoscopy. Results 18 728 people chose quantitative immunoassay FOBT and 6 212 people chose double-method FOBT at the same time. There was no significant difference in gender and age between the two groups (all P>0.05), which was comparable. The detection rate of quantitative immune FOBT was higher than double-method FOBT (74.62% vs 32.23%, P<0.001). The positive rate of quantitative immune FOBT in primary screening was lower than double-method FOBT (4.11% vs 5.34%, P=0.003). The colonoscopy screening rate in positive population by quantitative immune FOBT was higher than double-method FOBT (27.83% vs 13.08%, P=0.001). These differences were statistically significant. The detection rate of total lesions by colonoscopy was 71.88% in positive population by quantitative immune FOBT. It was 42.86% in double-method FOBT. There was no statistical difference between the two methods (P=0.05). The detection rates of quantitative immune FOBT were significantly different among different genders, ages and physical properties (all P<0.001). The detection rate was higher in males than in females (79.14% vs 68.75%). The detection rate was highest in the group between 40 and 59 years old (79.96%). The individual detection rate was higher than the group (90.08% vs 66.07%). The positive rates in primary screening were significantly different among different ages (P=0.001).It was highest in the group aged 60 or above (5.59%). The colonoscopy screening rate in positive population by quantitative immune FOBT was highest in the group aged 50 or above (36.96%). The detection rate of inflammatory lesions were significantly different among different ages (P<0.001). The detection rate of colorectal cancer in males was higher than in females (11.11% vs 0.00%, P=0.009). In addition, with the increasing of fecal occult blood value, the detection rate of cancer was increased (P=0.041). Conclusion The quantitative immune FOBT is an ideal non-invasive examination for early screening of colorectal cancer. It has important application values.

Application of urinary 5-aminolevulinic acid detection in screening and identification of colorectal cancer and adenomatous polyps / 中国医师进修杂志

Objective@#To study the application of urinary 5-aminolevulinic acid (5-ALA)detection in screening and identification of colorectal cancer and adenomatous polyps.@*Methods@#The clinical data of 500 high-risk patients(including 22 cases with colorectal cancer, 134 cases with adenomatous polyps, and 344 cases with other patients) at the First Affiliated Hospital of Hebei North University from January 2018 to October 2018 were collected. High performance liquid chromatography(HPLC) was used to detect urinary 5-ALA and fecal occult blood test was used to detect faeces. Sensitivity and specificity of two methods was compared. At the same time, urine samples of 431 cases(including 22 cases with colorectal cancer, 134 cases with adenomatous polyps and 275 cases with colorectal normal mucosa)were collected, and the difference of the content of urinary 5-ALA among three groups was compared.@*Results@#The sensitivity of urinary 5-ALA for the colorectal cancer screening was74.9%, and the specificity was 72.5%. The sensitivity of urinary 5-ALA for the adenomatous polyps screening was 70.1%, and the specificity was75.0%. The sensitivity of fecal occult blood test for the colorectal cancer screening was 63.6%, and the specificity was 62.1%. The sensitivity of fecal occult blood test for the adenomatous polyps screening was 42.3%, and the specificity was 62.5%. The content of urinary 5-ALA of the colorectal cancer group [(9.35 ± 0.46) μmol/g] was significantly higher than that of the adenomatous polyps group [(7.24 ± 0.64) μmol/g] (P < 0.05) and normal colorectal mucosa group [(3.12 ± 0.24) μmol/g] (P < 0.05), and the content of urinary 5-ALA of the adenomatous polyps group was significantly higher than that of colorectal normal mucosa group (P < 0.05).@*Conclusions@#For screening of colorectal cancer and adenomatous polyps, the content of urinary 5-ALA by HPLC is better than fecal occult blood test, and this approach can do great help to identify colorectal cancer, adenomatous polyps and normal colorectal mucosa.

Significance of fecal occult blood test in colorectal cancer screening / 肿瘤研究与临床

Colorectal cancer is one of the most common malignant tumors of the digestive system. The incidence of colorectal cancer in China is increasing year by year. Screening for adenomas, precancerous lesions and early cancers can effectively reduce the incidence and mortality of colorectal cancer. Therefore, colorectal cancer screening is particularly important. At present, the colorectal cancer examination is mainly divided into fecal examination and colon structural examination. The fecal examination includes fecal occult blood test, fecal exfoliated cell test and fecal genetic analysis. The colon structural examination includes barium enema, colonoscopy and computed tomography colonography. Colonoscopy is considered as the gold standard for the diagnosis of colorectal cancer. It has the advantage of high accuracy, and can be used to find precancerous lesions and remove them at the same time. However, the screening should be greatly restricted because of its invasive examination, the need for intestinal preparation, obvious discomfort and the high cost of medical treatment. Comparatively, fecal occult blood test is simple, easy, non-invasive, saving manpower and material resources, and is suitable for large population screening. Some scholars in China have begun to pay attention to colorectal cancer screening, and fecal occult blood test is widely used in these screenings.

Clinical Utility of Fecal Immunochemical Transferrin Test in Gastrointestinal Bleeding Detection / 대한임상미생물학회지

BACKGROUND: Gastrointestinal (GI) bleeding can result from various conditions, including ulcers, neoplasms and infectious enterocolitis. The aim of this study was to evaluate the utility of the fecal immunochemical transferrin test compared with the fecal Hb test in various clinical settings. METHODS: A total of 1,116 clinical stool specimens submitted for fecal occult blood testing were prospectively examined using both FIT Hb and FIT Tf kits (AlfresaPharma, Japan). To verify the specificity of the two tests, stool specimens from 265 health check-up examinees were also included. RESULTS: A review of medical records revealed that 396 patients had clinical conditions associated with GI bleeding. FIT Hb and FIT Tf results were positive in 156 (39.4%) and 137 (34.6%) cases, respectively, and an additional 194 (49.0%) cases tested positive with either FIT Hb or FIT Tf. The two tests showed a moderate strength of agreement (kappa value; 0.56). Colitis (n=71) was associated with the most GI bleedings, followed by acute gastroenteritis (n=29), GI ulcers (n=27) and GI cancers (n=15). While the first two groups had higher positive rates on FIT Tf, patients in the latter two groups had higher positive rates on FIT Hb. Notably, four of nine specimens from premature babies tested positive only on FIT Tf. The specificity of FIT Hb and FIT Tf was 100% and 99.6%, respectively. CONCLUSION: Concurrent use of FIT Hb and FIT Tf improved the detection rate of occult GI bleeding, especially in patients with infectious GI disease (such as colitis or gastroenteritis) and in premature babies.

Quality Metrics of a Fecal Immunochemical Test-Based Colorectal Cancer Screening Program in Korea

BACKGROUND/AIMS: Knowledge regarding the quality metrics of fecal immunochemical test (FIT)-based colorectal cancer screening programs is limited. The aim of this study was to investigate the performance and quality metrics of a FIT-based screening program. METHODS: In our screening program, asymptomatic subjects aged ≥50 years underwent an annual FIT, and subjects with positive FIT results underwent a subsequent colonoscopy. The performance of the FIT and colonoscopy was analyzed in individuals with a positive FIT who completed the program between 2009 and 2015 at a university hospital. RESULTS: Among the 51,439 screened participants, 75.1% completed the FIT. The positive rate was 1.1%, and the colonoscopy completion rate in these patients was 68.6%. The positive predictive values of cancer and advanced neoplasia were 5.5% and 19.1%, respectively. The adenoma detection rate in the patients who underwent colonoscopy after a positive FIT was 48.2% (60.0% for men and 33.6% for women). The group with the highest tertile quantitative FIT level showed a significantly higher detection rate of advanced neoplasia than the group with the lowest tertile (odds ratio, 2.6; 95% confidence interval, 1.4 to 5.1; p < 0.001). CONCLUSIONS: The quality metrics used in the United States and Europe may be directly introduced to other countries, including Korea. However, the optimal quality metrics should be established in each country.

Patients' Preferences for Primary Colorectal Cancer Screening: A Survey of the National Colorectal Cancer Screening Program in Korea

BACKGROUND/AIMS: The adoption of colonoscopy as a primary colorectal cancer (CRC) screening technique has been argued for in Korea, without evidence of patient preferences. This study aimed to investigate patients’ preferences for the primary CRC screening test for the National Cancer Screening Program (NCSP). METHODS: Between June and August 2016, 414 individuals aged ≥50 years who participated in the NCSP were prospectively invited to complete a questionnaire regarding their preferences for the primary CRC screening test and the reasons for their selection. RESULTS: Among the 396 respondents who completed the questionnaire, 124 individuals (31.3%) preferred the fecal immunochemical test (FIT), whereas 272 individuals (68.7%) preferred colonoscopy. Elderly participants preferred the FIT (p < 0.001), whereas participants with a higher education level (p=0.030), a higher income level (p=0.009), or individuals with a family member (p=0.028) or acquaintance (p=0.013) with a history of CRC preferred colonoscopy. Only 12.9% of participants had a bad experience with a previous FIT; however, 39.3% of participants had a bad experience with a previous colonoscopy. CONCLUSIONS: Colonoscopy was preferred to FIT in a 2.2:1 ratio as the primary CRC screening test for the NCSP. Patients’ preference for colonoscopy should be considered for the NCSP in Korea.

Colorectal Cancer Screening Using Immunochemical Fecal Occult Blood Test

Fecal occult blood test (FOBT) screening has been shown to decrease the incidence and mortality of colorectal cancer (CRC). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the immunochemical fecal occult blood test (i-FOBT) in diagnosing CRC were assessed among the patients in a tertiary referral hospital in Malaysia. A total sample of 814 patients aged 16 to 85 years old who performed i-FOBT and endoscopic screenings was obtained. The patients were recruited for a retrospective investigation. Sensitivity, specificity, PPV, and NPV were derived for the CRC screenees. Out of the 814 patients screened using i-FOBT, half of them were above 59 years old (49.6%), and 36% had positive i-FOBT. Gender distribution was almost equal, where 53.4% of the patients were female, and 46.6% were male. Majority of the patients were Malays (56.6%), followed by Chinese (24.0%), Indians (16.5%), and others (2.9%). Among the 71 patients referred for colonoscopy, 57.7% and 42.3% corresponded to positive and negative i-FOBT cases, respectively. Polyps were found to be most common among the patients (25.6%), 7.0% were found positive for invasive CRC, and 35.2% had normal colonoscopic findings. There was a significant association between colonoscopic finding and positive i-FOBT (p=0.001). The sensitivity, specificity, PPV, and NPV for CRC detection were 66.7%, 43.0%, 9.8%, and 93.3%, respectively. The results indicate that i-FOBT is a useful tool in the detection of abnormalities in the lower gastrointestinal tract and therefore serves as a cornerstone for potential large-scale screening programmes.

Fecal immunochemical test followed by colonoscopy in opportunistic screening for colorectal neoplasm / 中华全科医师杂志

Objective To assess the fecal immunochemical test (FIT) followed by colonoscopy in opportunistic screenings for colorectal neoplasm.Methods Total 6 193 patients, who underwent opportunistic colorectal cancer (CRC) screening, were classified into four groups: 3 812 patients underwent direct colonoscopy (group 1), 1 244 patients received one FIT followed by colonoscopy (group 2), 341 patients received two FITs followed by colonoscopy (group 3), and 796 patients received three FITs followed by colonoscopy (group 4).Results Total 97 (1.6%) patients with CRC and 1 038 (16.8%) with colorectal adenoma were detected.The positive predictive value of 1, 2 and 3 positive tests out of three FITs for CRC were 4.53%, 5.62% and 8.94%, respectively, which was higher than that of direct colonoscopy (1.52%).One or more positive tests out of three FIT had the largest area under receiver operating characteristic curve (0.743).For colorectal adenoma, detection rate of direct colonoscopy (17 581.25/105) was higher than all FIT strategies (3 732.30/105-13 127.41/105).Conclusions Single or repeated FIT and colonoscopy have different screening utility.One or more positive tests out of three FIT followed by colonoscopy is preferred to screen CRC, and direct colonoscopy is better for detection of colorectal adenoma.

Performance Evaluation of Two Automated Quantitative Fecal Occult Blood Tests

BACKGROUND: The performance of the fecal occult blood test (FOBT) has recently improved with the use of quantitative immunochemical assays. We evaluated the two latest immunochemical FOBTs: OC-Sensor PLEDIA (Eiken Chemical, Japan) and NS-Prime (Alfresa Pharma, Japan). METHODS: The precision was evaluated by using the quality control materials at two levels and carry-over rates were measured at high and low concentrations of the sample, prepared from the calibrators. Linearity was measured by using five concentrations of human hemoglobin (0-1,000 ng/mL), prepared from erythrocyte lysates. Correlation between the two systems was analyzed by testing approximately 50 selected stool specimens per day and comparing the results obtained with those of the currently used analyzer, OC-Sensor DIANA (Eiken Chemical), for 10 consecutive working days. RESULTS: The variation for repeatability, between-run, between-day, and intermediate precision at both levels was 0.99 for both systems. In total, 499 stool specimens were analyzed, of which 127 (25.5%), 130 (26.1%), and 129 (25.9%) specimens tested positive by DIANA, PLEDIA, and NS-Prime, respectively. The agreement between PLEDIA and NS-Prime was 98.4%. Quantification by PLEDIA was linear to that by NS-Prime (y=1.0372x+17.744; r²=0.9064). CONCLUSIONS: The analytical performances of PLEDIA and NS-Prime warrant their use as diagnostic tests. They showed excellent categorical agreement; however, the quantitative value obtained by NS-Prime was lower than that obtained by PLEDIA.

Adenoma detection rate of fecal occult blood test-positive population in colorectal cancer screening and potential influence of“resection and discard”strategy / 中华消化内镜杂志

Objective To evaluate the adenoma detection rate( ADR)of fecal occult blood test (FOBT)-positive population in colorectal cancer screening programme and to analyse potential influence of“resection and discard”strategy on ADR. Methods Data of patients who paticipated in the Shanghai color-ectal cancer screening programme with FOBT-positive and received colonoscopy in the Digestive Endoscopic Center of Changhai Hospital from July 2013 to July 2014 were retrospectively analysed. ADR was calculated and compared by different genders. Multivariate logistic regression model was used to analyse the risk factors of polyp resection without retrieval. Results A total of 222 FOBT-positive patients were involved with 36. 5% male proportion. The total ADR was 19. 8%,higher in male(28. 4%)than in female(14. 9%)(P=0. 015). The independent risk factors of polyp resection without retrieval were diminutive polyp( OR =15. 256,95% CI:4. 159-55. 957),located in rectum( OR = 3. 663,95% CI:1. 427-9. 398) and polyp number >2(OR= 3. 988,95%CI:1. 562-10. 187).Conclusion ADR of FOBT-positive population is approx-imately 20%in our center. Low male proportion and“resection and discard”strategy may lead to lower ADR. ADR should be calculated by different genders and advanced endoscopic technology should be employed rou-tinely to predict the pathological diagonosis of the lesions.

Performance Evaluation of the HM-JACKarc Analyser for Fecal Occult Blood Test

BACKGROUND: Fecal occult blood tests have been widely used as a means of gastrointestinal bleeding and colorectal cancer screening. HM-JACKarc (Kyowa Medex Co. Ltd, Japan) is a recently introduced automated fecal occult blood test analyser, which uses latex agglutination method. We evaluated the analytical performance of HM-JACKarc. METHODS: The linearity and precision for HM-JACKarc were evaluated according to the corresponding Clinical and Laboratory Standard Institute guidelines. The comparison study between HM-JACKarc and OC-SENSOR DIANA (Eiken Chemical Co. Ltd., Japan) was done with stool specimens. RESULTS: The linearity was good (R²=0.999) and the coefficients of variation of within-day precision and between-day precision were 5.2% and 4.9%, respectively, in low concentration and 2.7% each in high concentration. The concordance rate between HM-JACKarc and OCSENSOR DIANA was 99.0% (198 out of 200). CONCLUSIONS: HM-JACKarc showed excellent performance in linearity, precision, and comparison studies. Therefore, it appears to be a useful automated fecal occult blood test analyser.

Inmunoexpresión p53, sangre oculta en heces de pacientes colecistectomizados y colelitiasis con adenomas colónicos / P53 Immunoexpression, Faecal Occult Blood from Cholecystectomized Patients and Cholelithiasis with Colonic Adenomas

Introducción: la secuencia adenoma- adenocarcinoma, es resultado de fallos genéticos en las células intestinales heredados o adquiridos. Objetivo: determinar la posible relación entre la inmunoexpresión de la p53 y la positividad de la sangre oculta en heces en los adenomas de colon con alto grado de displasia diagnosticados en pacientes colecistectomizados o con colelitiasis. Métodos: se realizó un estudio descriptivo, de corte transversal, en el Instituto de Gastroenterología, en el período de mayo de 2013 hasta junio de 2015. Se realizaron pruebas estadísticas descriptiva y de chi Cuadrado y probabilidad exacta de Fisher. Resultados: la proporción de adenomas con alto grado de displasia fue similar en pacientes colecistectomizados y con colelitiasis (50 por ciento) respectivamente. Una alta proporción se diagnosticó en colecistectomizados femeninas (35 por ciento), con 60 y más años de edad (53 por ciento) y 11 y más años de colecistectomizados (60 por ciento), mientras que en las colelitiasis fueron masculinos (30 por ciento). Conclusiones: una alta proporción de adenomas con alto grado de displasia presentan inmunoexpresión de la p53 y sangre en heces positiva en pacientes colecistectomizados y con colelitiasis, que se reporta por vez primera(AU)

Introduction: The adenoma - adenocarcinoma sequence is a result of inherited or acquired genetic failures in the intestinal cells. Objective: To determine the immunohistochemical expression of p53 and the positivity of the fecal occult blood test in colon adenomas with high degree of diagnosed dysplasia in cholecystectomized patients or with cholelithiasis. Methods: Descriptive, cross-sectional study conducted in the Institute of Gastroenterology in the period of May, 2013 to June, 2015. Statistical tests were statistics testing, exact Chi Square and Fisher's probability tests. Results: The proportion of adenomas with high degree of dysplasia was similar in cholecystectomized patientsand with cholelithiasis (50 percent) respectively. A high proportion diagnosed in colecistectomizados women (35 percent), 60 and more years of age (53 percent) and 11 and more years of performed cholecystectomy (60 percent), whereas cholelithiasis prevailed in males (30 percent). Conclusions: High proportion of adenomas with high degree of dysplasia present p 53 immunoexpression and positive fecal occult blood test in cholecystectomized patients and patients with cholelithiasis that is reported for the first time(AU)