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Comparison of faecal M2-PK and FIT in a population-based bowel cancer screening cohort

Leen, Ronan; Seng-Lee, Chun; Holleran, Grainne; O’Morain, Colm; McNamara, Deirdre

European Journal of Gastroenterology & Hepatology: May 2014 - Volume 26 - Issue 5 - p 514–518
doi: 10.1097/MEG.0000000000000025
Original Articles: Colorectal Cancer

Background Screening for colorectal cancer improves outcomes and is cost effective. Stool-based tests have the highest participation rates in screening programmes. Their efficacy is limited by the relatively low sensitivity and specificity compared with colonoscopy. Stool levels of M2-PK, a dimeric form of the enzyme pyruvate kinase, correlate with colorectal cancer and neoplasia. A combination of stool markers may enhance screening performance; however, it remains to be determined whether an additional test would affect participation rates negatively.

Aims The aim of this study was to assess the performance of faecal M2-PK and faecal immunochemical test (FIT) and their combined effect in a screening programme.

Materials and methods Within round 2 of our biennial FIT-based pilot, all invitations additionally included an M2-PK kit. A FIT greater than 100 ngHb/ml and/or an M2-PK greater than 4 U/ml were considered positive. FIT-positive or M2-PK-positive patients were offered a colonoscopy.

Results In all, 1800 combined M2-PK and FIT invites were sent out, and 879 (49%) samples were analysed. Overall positivity was 27% (n=245). Only 23 (2.6%) patients were positive for both tests. In all, 186 (88%) screening colonoscopies were performed. The adenoma detection rate for M2-PK-positive patients (n=157) was significant at 25% (n=40), and 3% (n=5) had advanced lesions. In FIT-positive patients (n=51), the adenoma detection rate was 29% (n=15), with significantly more, 21% (n=11), having advanced lesions (P<0.001, confidence interval 0.117–0.156). Had FIT only been tested, 70% (n=35) fewer patients would have had polyps removed.

Conclusion The addition of M2-PK in a biennial bowel screening programme is acceptable to patients, feasible and detects additional adenomas, potentially at an earlier stage.

Department of Gastroenterology & Clinical Medicine, Trinity Centre, Tallaght Hospital, Trinity College Dublin, Dublin, Ireland

Correspondence to Deirdre McNamara, MD, Department of Gastroenterology & Clinical Medicine, Trinity Centre, Tallaght Hospital, Trinity College Dublin, Dublin 24, Ireland Tel: +353 1 8963844; fax: +353 1 8962988; e-mail:

Received October 8, 2013

Accepted November 18, 2013

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins