Application of quantitative and qualitative fecal immunochemical test in screening colorectal cancer and advanced adenoma

doi:10.3877/cma.j.issn.2095-2015.2025.03.015

Abstract

Abstract:

Objective

To explore the application value of quantitative and qualitative fecal immunochemical test (FIT) in screening colorectal cancer (CRC) and advanced adenoma.

Methods

A total of 100 patients with suspected CRC undergoing colonoscopy in Huainan Xinhua Hospital were enrolled as the research objects between January 2023 and June 2024.The stool samples were collected before colonoscopy for detection by quantitative and qualitative FIT.Taking colonoscopy+pathological diagnosis as the golden standard, detection rates of CRC and advanced adenoma by quantitative and qualitative FIT, as well as sensitivity, specificity, positive predictive values and negative predictive values of quantitative and qualitative FIT in the diagnosis of CRC and advanced adenoma under different cut-off values were compared.The basic clinical data of patients in progressive tumor group, polyp group and normal group were analyzed by univariate analysis, and risk factors of progressive tumor were analyzed by multivariate Logistic regression analysis.

Results

The results of colonoscopy and pathological examination showed that among the 100 patients, there were 4 cases (4.00%) with CRC and 19 cases (19.00%) with advanced adenoma.The detection rates of CRC and advanced adenoma by quantitative FIT were 4.00%and 19.00%, while which by qualitative FIT were 2.00% and 16.00%, respectively.When cut-off values of fecal hemoglobin were 20, 50 and 100 ng/mL, sensitivity of quantitative FIT in the diagnosis of CRC was decreased from 100% to 66.67%, the sensitivity of qualitative FIT for detecting CRC was 66.67%, lower than that of quantitative FIT under cut-off value of 20 ng/mL.The results of McNemar's test with paired chi-square test showed that when the cut-off value was 20 ng/mL, the difference in consistency between qualitative and quantitative FIT was statistically significant (χ²=4.00, P=0.046).When cut-off values were 50 and 100 ng/mL, the difference in consistency between qualitative and quantitative FIT was not statistically significant (P>0.05).Under the same hemoglobin concentration gradient, the sensitivity of FIT in the diagnosis of advanced adenoma was decreased from 76.00% (20 ng/mL) to 57.14% (100 ng/mL).The sensitivity of qualitative FIT for detecting advanced adenoma was 50.00%, lower than that of quantitative FIT under cut-off value of 20 ng/mL.The results of McNemar's test with paired chi-square test showed that the difference in consistency between qualitative and quantitative FIT was not statistically significant under different cut-off values (P>0.05).

Conclusion

The detection rates of CRC and advanced adenoma are higher by quantitative FIT, and detection sensitivity is higher when cut-off value of fecal hemoglobin is 20 ng/mL, it significantly tends to determine more samples as positive when judging CRC

Key words: Colorectal cancer, Advanced adenoma, Fecal immunochemical test, Quantitative method, Qualitative method, Diagnostic efficiency

Yaqi Wang, Yangliang Li, Ping Lu. Application of quantitative and qualitative fecal immunochemical test in screening colorectal cancer and advanced adenoma[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(03): 267-271.

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References 18

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定量FIT 阈值	定性FIT 阳性	定性FIT 阴性	定性FIT 阳性	定量FIT 阴性
20 ng/mL	2	98	4	96
50 ng/mL	2	98	2	98
100 ng/mL	2	98	1	99

定量FIT 阈值	定性FIT 阳性	定性FIT 阴性	定性FIT 阳性	定量FIT 阴性
20 ng/mL	2	98	4	96
50 ng/mL	2	98	2	98
100 ng/mL	2	98	1	99

方法	真阳性(例)	假阳性(例)	真阴性(例)	假阴性(例)	敏感度(%)	特异度(%)	阳性预测值(%)	阴性预测值(%)
定量FIT
20 ng/mL	4	1	95	0	100.00	98.96	80.00	100.00
50 ng/mL	3	3	93	1	75.00	96.88	50.00	98.94
100 ng/mL	4	1	93	2	66.67	98.94	80.00	97.89
定性FIT	2	1	96	1	66.67	98.97	66.67	98.97

方法	真阳性(例)	假阳性(例)	真阴性(例)	假阴性(例)	敏感度(%)	特异度(%)	阳性预测值(%)	阴性预测值(%)
定量FIT
20 ng/mL	4	1	95	0	100.00	98.96	80.00	100.00
50 ng/mL	3	3	93	1	75.00	96.88	50.00	98.94
100 ng/mL	4	1	93	2	66.67	98.94	80.00	97.89
定性FIT	2	1	96	1	66.67	98.97	66.67	98.97

定量FIT 阈值	定性FIT 阳性	定性FIT 阴性	定量FIT 阳性	定量FIT 阴性
20 ng/mL	19	81	16	84
50 ng/mL	16	84	17	83
100 ng/mL	16	84	15	85

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