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Ann Intern Med:粪便免疫化学检测可有效检出结直肠肿瘤

2014-03-04 佚名 丁香园

尽管进行结直肠癌的筛查有助于早期发现肿瘤,但使用粪便免疫生物学检测方法筛查结直肠癌的效果存在差异。为此,来自美国加州大学健康研究中心的Jeffrey博士等人进行了一项研究,从而验证粪便免疫化学检测诊断结直肠癌的精度并明确影响其结果的因素。研究结果发表在2014年1月4日的Ann Intern Med上,作者发现进行粪便免疫化学检测筛查结直肠癌有较高的准确性。 该研究是

尽管进行结直肠癌的筛查有助于早期发现肿瘤,但使用粪便免疫生物学检测方法筛查结直肠癌的效果存在差异。为此,来自美国加州大学健康研究中心的Jeffrey博士等人进行了一项研究,从而验证粪便免疫化学检测诊断结直肠癌的精度并明确影响其结果的因素。研究结果发表在2014年1月4日的Ann Intern Med上,作者发现进行粪便免疫化学检测筛查结直肠癌有较高的准确性。

该研究是一个荟萃分析,数据来源于1996年至2013年间Pubmed和EMBASE中的相关研究。涉及粪便免疫化学检测诊断无症状、中危成年人结直肠癌效果的研究纳入分析。

最终有19篇合格文章纳入研究并进行了荟萃分析。经分析,粪便免疫化学检测诊断结直肠癌的敏感性、特异性、阳性似然比和阴性似然比分别为0.79、0.94、13.10和0.23,总体诊断精确性为95%.单样本检测的敏感性和特异性与多样本检测相似,与粪便免疫化学检测试剂盒的品牌无关。

该研究发现,粪便免疫化学检测在发现结直肠癌上具有中等程度的敏感性,较高的特异性,并且有很高的总体诊断精确性。诊断性能取决于阳性结果的截断值。

研究背景

结直肠癌在美国是肿瘤导致死亡的第二大病因。随机对照试验已经证实每年或每两年进行粪便隐血试验可以降低15%-33%的结直肠癌死亡率。然而,在无症状人群中进行一次粪便隐血试验仅仅能检测出约13%-50%的结直肠癌患者。另外,现实中能够坚持定期做粪便隐血试验筛查的人较少,这也使人担心粪便隐血试验作为筛查手段的有效性。

粪便免疫化学检测发现结直肠癌及腺瘤与粪便隐血试验相比有更高的敏感性。多数粪便免疫化学检测试剂盒仅仅需要1或2个粪便标本,并且不需要饮食和药物限制,增加了使用的便利性。在2008年,多个美国专业协会赞同使用粪便免疫化学检测替代粪便隐血试验,因为前者具有更好的诊断性能且有更高的参与率。

欧洲及亚洲国家已经广泛采用粪便免疫化学检测进行结直肠癌筛查。然而,报道的诊断敏感性差别较大(25%——100%),并且特异性常超过90%.其敏感性缺少精确的评估导致医务工作者在为患者提供服务时产生困惑。为了更好地应用粪便免疫化学检测作为结直肠癌筛查的工具,确定阳性结果合理的截断值,并且判断不同品牌试剂盒是否存在差异,研究人员进行了此项荟萃分析。

原始出处:

Jeffrey K. Lee, MD, MAS; Elizabeth G. Liles, MD, MCR; Stephen Bent, MD; Theodore R. Levin, MD; and Douglas A. Corley, MD, PhD.Accuracy of Fecal Immunochemical Tests for Colorectal Cancer: Systematic Review and Meta-analysis.Ann Intern Med. 2014;160(3):171-181-181. doi:10.7326/M13-1484

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    2014-03-06 Homburg
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