Dataset Information

Diagnostic accuracy of fecal calprotectin for screening patients with colorectal cancer: A meta-analysis.

ABSTRACT:

Background/aims

Fecal calprotectin (FC) is reported to have a broad diagnostic accuracy for colorectal cancer (CRC). Therefore, we explored the diagnostic value of FC for CRC using meta-analytical techniques to substantiate the assertion.

Materials and methods

An electronic search of the MEDLINE and Embase databases was conducted to identify studies that assessed the diagnostic accuracy of FC for CRC. The sensitivities and specificities of the eligible studies were summarized using a bivariable random-effects model.

Results

In total, 20 studies were included in the final analysis. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of FC for CRC detection were 0.83 (95% confidence interval CI, 0.77-0.88), 0.61 (95% CI, 0.54-0.68), 2.15 (95% CI, 1.82-2.55), and 0.28 (95% CI, 0.21-0.37), respectively. The overall diagnostic odds ratio of FC for CRC was 7.76 (95% CI, 5.41-11.12) with an area under the curve of 0.81 (95% CI, 0.77-0.84), whereas the diagnostic value of FC for colorectal adenoma was relatively inferior (area under the curve, 0.55; 95% CI, 0.51-0.59; diagnostic odds ratio, 1.27; 95% CI, 0.91-1.78).

Conclusion

The results imply that the FC test, as currently implemented, cannot be recommended for CRC detection.

SUBMITTER: Ye X

PROVIDER: S-EPMC6284629 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Publications

Diagnostic accuracy of fecal calprotectin for screening patients with colorectal cancer: A meta-analysis.

Ye Xiaohua X Huai Jiaping J Ding Jin J

The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology 20180701 4

<h4>Background/aims</h4>Fecal calprotectin (FC) is reported to have a broad diagnostic accuracy for colorectal cancer (CRC). Therefore, we explored the diagnostic value of FC for CRC using meta-analytical techniques to substantiate the assertion.<h4>Materials and methods</h4>An electronic search of the MEDLINE and Embase databases was conducted to identify studies that assessed the diagnostic accuracy of FC for CRC. The sensitivities and specificities of the eligible studies were summarized usin ...[more]

PMID: 30249553

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Project description:ImportanceThe potential role of the fecal immunochemical test (FIT) for screening patients at increased risk for colorectal cancer (CRC) has not yet been elucidated.ObjectiveTo assess the diagnostic accuracy of FIT for CRC or advanced neoplasia (AN) in asymptomatic patients at above-average risk.Data sourcesMEDLINE, EMBASE, Cochrane Library, and gray literature sources through August 2016.Study selectionDiagnostic studies evaluating the accuracy of FIT for CRC or AN in patients with a personal or familial history of CRC using colonoscopy as the reference standard.Data extraction and synthesisTwo authors (A.K. and P.P.) independently extracted data and evaluated study quality using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, and evaluated the quality of the body of evidence by means of GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Hierarchical models were used to synthesize available evidence.Main outcomes and measuresThe primary outcome was the diagnostic performance of FIT for detecting CRC or AN.ResultsWe included 12 studies (6204 participants). Seven studies were deemed at high or unclear risk of bias. The average sensitivity of FIT for CRC was 93% (95% CI, 53%-99%), and the average specificity was 91% (95% CI, 89%-92%), yielding a positive likelihood ratio (LR+) of 10.30 (CI 7.7-13.9) and a negative likelihood ratio (LR-) of 0.08 (95% CI, 0.01-0.75) (GRADE: very low). The average sensitivity of FIT for AN was 48% (95% CI, 39%-57%); and the average specificity was 93% (95% CI, 91%-94%), yielding an LR+ of 6.55 (95% CI, 5.0-8.5) and an LR- of 0.57 (95% CI, 0.48-0.67) (GRADE: very low). Subgroup analyses indicated that FIT cutoff values between 15- and 25-μg/g feces provided the best combination of sensitivity and specificity for the diagnosis of CRC (93% and 94%, respectively). Quantitative and 1-sample FIT showed adequate test performance, but data on other FIT brands and multiple samples were insufficient.Conclusions and relevanceThe FIT has high overall diagnostic accuracy for CRC but moderate accuracy for AN in patients at above-average personal or familial risk. Heterogeneity and wide confidence intervals limit the trustworthiness of our findings.

Project description:BackgroundPerformance characteristics of fecal immunochemical tests (FITs) to screen for colorectal cancer (CRC) have been inconsistent.PurposeTo synthesize data about the diagnostic accuracy of FITs for CRC and identify factors affecting its performance characteristics.Data sourcesOnline databases, including MEDLINE and EMBASE, and bibliographies of included studies from 1996 to 2013.Study selectionAll studies evaluating the diagnostic accuracy of FITs for CRC in asymptomatic, average-risk adults.Data extractionTwo reviewers independently extracted data and critiqued study quality.Data synthesisNineteen eligible studies were included and meta-analyzed. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of FITs for CRC were 0.79 (95% CI, 0.69 to 0.86), 0.94 (CI, 0.92 to 0.95), 13.10 (CI, 10.49 to 16.35), 0.23 (CI, 0.15 to 0.33), respectively, with an overall diagnostic accuracy of 95% (CI, 93% to 97%). There was substantial heterogeneity between studies in both the pooled sensitivity and specificity estimates. Stratifying by cutoff value for a positive test result or removal of discontinued FIT brands resulted in homogeneous sensitivity estimates. Sensitivity for CRC improved with lower assay cutoff values for a positive test result (for example, 0.89 [CI, 0.80 to 0.95] at a cutoff value less than 20 µg/g vs. 0.70 [CI, 0.55 to 0.81] at cutoff values of 20 to 50 µg/g) but with a corresponding decrease in specificity. A single-sample FIT had similar sensitivity and specificity as several samples, independent of FIT brand.LimitationsOnly English-language articles were included. Lack of data prevented complete subgroup analyses by FIT brand.ConclusionFecal immunochemical tests are moderately sensitive, are highly specific, and have high overall diagnostic accuracy for detecting CRC. Diagnostic performance of FITs depends on the cutoff value for a positive test result.Primary funding sourceNational Institute of Diabetes and Digestive and Kidney Diseases and National Cancer Institute.

Dataset Information

Diagnostic accuracy of fecal calprotectin for screening patients with colorectal cancer: A meta-analysis.

Background/aims

Materials and methods

Results

Conclusion

Publications

Diagnostic accuracy of fecal calprotectin for screening patients with colorectal cancer: A meta-analysis.

Similar Datasets

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