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European Journal of Gastroenterology & Hepatology:
doi: 10.1097/MEG.0b013e3283293797
Original Articles: Colorectal Cancer

Screening for familial colorectal cancer with a sensitive immunochemical fecal occult blood test: a pilot study

Gimeno-García, Antonio Z.a; Quintero, Enriquea; Nicolás-Pérez, Davida; Hernández-Guerra, Manuela; Parra-Blanco, Adolfoa; Jiménez-Sosa, Alejandrob

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Abstract

Objective: Colonoscopy is empirically recommended as the first choice screening strategy in first-degree relatives of patients with colorectal cancer (CRC). However, this strategy is accepted by less than 40% of the risk population and two-thirds of screened individuals and renders a normal exploration. This pilot study assessed the accuracy of a latex agglutination immunochemical fecal occult blood test (LA-FOBT) for detecting advanced colorectal neoplasm (cancer or adenomatous polyps ≥1 cm in size, with villous pattern or high grade dysplasia) in asymptomatic first-degree relatives of patients with CRC.

Methods: One hundred and sixty-nine first-degree relatives of 135 index cases were prospectively included. All participants received a sensitive LA-FOBT (hemoglobin detection limit of 50 ng/ml buffer), and were invited to undergo colonoscopy. On the whole, 116 (69%) participants returned LA-FOBT and underwent colonoscopy.

Results: LA-FOBT was positive in 19 of 116 (16%) cases. Colonoscopy detected neoplasms in 49 of 116 (42%) patients: 37 of 116 (32%) were nonadvanced adenomas and 12 of 116 (10%) advanced adenomas. LA-FOBT detected 10 of 12 (83%) advanced adenomas showing a sensitivity, specificity, positive predictive value, and negative predictive value of 83, 91, 53, and 98%, respectively. In patients with positive LA-FOBT, 1.9 colonoscopies were necessary for detecting one advanced adenoma, whereas in case of not performing this test 10 colonoscopies would be needed. Overall, approximately 80% of screening colonoscopies could be precluded using a LA-FOBT.

Conclusion: One-time screening with LA-FOBT successfully detects advanced colorectal adenomas and may save unnecessary colonoscopies in first-degree relatives of patients with CRC.

© 2009 Lippincott Williams & Wilkins, Inc.

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