Review and Meta-analysis Finds FIT CRC Sensitivity Lower in Stage I and T1
Douglas K. Rex, MD, FASGE reviewing Niedermaier T, et al. Am J Gastroenterol 2019 Dec 10.
Fecal immunochemical test (FIT) sensitivity for colorectal cancer (CRC) is often cited at about 80%, using the 20 microgram Hgb/g feces cut-off. However, it is important to know the stage-specific performance because detection of early stages has greater value than detection of late stages.
In a systematic review and meta-analysis of 44 studies, the pooled sensitivity estimates for stages I, II, III, and IV were 73%, 80%, 82%, and 79%, respectively, with significant differences between stages I versus II and I versus III. The pooled sensitivities by T stage showed more striking differences: the respective sensitivities for T1, T2, T3, and T4 were 40%, 79%, 83%, and 66%, with significantly lower sensitivity for T1 than each of the higher T stages.
COMMENT
This analysis is informative, suggesting that FIT sensitivity for T1 cancers is comparable to FIT sensitivity for advanced adenomas. The study is likely to be viewed as a modest setback to the rising enthusiasm for FIT as a CRC screening test.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Douglas K. Rex, MD, FASGE
CITATION(S)
Niedermaier T, Balavarca Y, Brenner H. Stage-specific sensitivity of fecal immunochemical tests for detection colorectal cancer: systematic review and meta-analysis. Am J Gastroenterol 2019 Dec 10. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000000465)
