Fecal occult blood and calprotectin testing to prioritize primary care patients for colonoscopy referral: The advantage study.

BACKGROUND: Colonoscopy is the gold standard for colorectal cancer (CRC) diagnosis and screening, but endoscopy services are usually overburdened. This study aims to investigate the usefulness of fecal hemoglobin (fHb) and calprotectin (FC) for the identification of patients with high probability of CRC who need urgent referral. METHODS: In a multicenter prospective study, we enrolled symptomatic patients referred from primary care for colonoscopy. Prior to bowel preparation, fHb and FC quantitative tests were performed. The diagnostic performance was estimated for each biomarker/combination. We built a multivariable predictive model based on logistic regression, translated to a nomogram and a risk calculator to assist clinicians in the decision-making process. RESULTS: The study included 1224 patients, of whom 69 (5.6%) had CRC. At the fHb cut-offs of >0 and 10 µg/g, the negative predictive values for CRC were 98.8% (95% confidence interval 97.8%-99.3%) and 98.6% (95%CI 97.7%-99.1%), and the sensitivities were 85.5% (95%CI 75.0%-92.8%) and 79.7% (95%CI 68.3%-88.4%), respectively. When we added the cut-off of 150 µg/g of FC to both fHb thresholds, the sensitivity of fecal tests improved. In the multivariate logistic regression model, the concentration of fHb was an independent predictor for CRC; age and gender were also independently associated with CRC. CONCLUSIONS: fHb and FC are useful as part of a triage tool to identify those symptomatic patients with high probability of CRC. This can be easily applied by physicians to prioritize high-risk patients for urgent colonoscopy.

[Advances in colorectal cancer screening]. / Avances en el cribado del cáncer colorrectal.

Colorectal cancer is one of the most prevalent neoplasms in our environment. Because of its characteristics, this disease is suitable for populational screening. However, the best procedure for screening for colorectal cancer in the population at intermediate risk has not been well defined. The present article discusses the most important advances in colorectal cancer screening presented in the meeting of the American Gastroenterological Association, with special emphasis on studies comparing different strategies. Advances in screening and surveillance of the population at high risk are also reviewed.

Avances en el cribado del cáncer colorrectal / Advances in colorectal cancer screening

El cáncer colorrectal es una de las neoplasias más prevalentesen nuestro medio y reúne varias características que la hacenuna enfermedad propicia para el establecimiento de medidasde cribado poblacional. Sin embargo, todavía no está bien establecidocuál es el mejor procedimiento para el cribado delcáncer colorrectal en población de riesgo medio. En esta revisiónse discuten las novedades más importantes, presentadasen el congreso de la American Gastroenterological Association,en cuanto a cribado de cáncer colorrectal, con especialénfasis en los estudios que comparan diferentes estrategias.Por otra parte, también se revisan novedades referentes alcribado y la vigilancia en la población de alto riesgo(AU)

Colorectal cancer is one of the most prevalent neoplasms inour environment. Because of its characteristics, this disease issuitable for populational screening. However, the best procedurefor screening for colorectal cancer in the population atintermediate risk has not been well defined. The present articlediscusses the most important advances in colorectal cancerscreening presented in the meeting of the American GastroenterologicalAssociation, with special emphasis on studiescomparing different strategies. Advances in screening andsurveillance of the population at high risk are also reviewed(AU)

Carcinoma colorrectal con alteración de la vía reparadora. Claves para su identificación y relevancia clínica / Mismatch-repair deficiency colorrectal carcinoma. Identification keys and clinical relevance

Un 7,5% de los carcinomas colorrectales (CCR) en España presenta alteraciones del sistema de reparación de errores de replicación del ADN (mismatch repair, MMR). De ellos, un 20% se desarrolla en pacientes que presentan el síndrome de Lynch. Para identificar a estos pacientes se utilizan criterios clínicos, moleculares, histopatológicos e inmunohistoquímicos. El análisis inmunohistoquímico de las proteínas reparadoras (MLH1, MSH2, MSH6 y PMS2) ha demostrado ser una técnica válida para la detección de tumores con alteración del MMR. La generalización del uso de la inmunohistoquímica hace que actualmente el patólogo desempeñe un papel fundamental en la identificación de pacientes con síndrome de Lynch

Colorectal carcinoma (CRC) in Spain shows mismatchrepair deficiency (MMR+) reaching a 7.5%. Twenty percent of them presents in Lynch syndrome. Identification of these patients is based on clinical, molecular, histopathologic and immunohistochemical criteria. Immunohistochemical analysis of mismatch-repair proteins (MLH1, MSH2, MSH6, and PMS2) is a valid technique to detect MMR+ tumors. The generalized use of immunohistochemistry confers to pathologists a fundamental role in the identification of patients with Lynch syndrome