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Systematic review and bivariate/HSROC random-effect meta-analysis of immunochemical and guaiac-based fecal occult blood tests for colorectal cancer screening

Launois, Roberta; Le Moine, Jean-Gabriela; Uzzan, Bernardb; Fiestas Navarrete, Lucia I.a; Benamouzig, Robertb

European Journal of Gastroenterology & Hepatology: September 2014 - Volume 26 - Issue 9 - p 978–989
doi: 10.1097/MEG.0000000000000160
Original Articles: Colorectal Neoplasia

Background Current literature evidences higher accuracy of immunological (iFOBT) vis-à-vis guaiac-based (gFOBT) fecal occult blood tests for colorectal cancer (CRC) screening. Few well-designed head-to-head comparisons exist.

Aim This meta-analysis assesses the performances of two iFOBTs compared with an established gFOBT using colonoscopy as the gold standard.

Methods We mobilized a bivariate and a hierarchical summary receiver operating characteristic (HSROC) model. Positive likelihood ratio (LR+) and negative likelihood ratio (LR) and diagnostic odds ratios were back-calculated. We constructed bivariate credibility ellipses in the HSROC space and calculated areas under the curve to obtain a global measure of test performance. Estimates are presented at 95% credibility levels.

Results We included and analyzed 21 studies. OC-Sensor was the best test for CRC screening, with high sensitivity (0.87; 95% credibility interval: 0.73–0.95) and specificity (0.93; 95% credibility interval: 0.84–0.96), optimal LR+ (12.01) and LR (0.14), and a high diagnostic odds ratio (88.05). Bivariate credibility ellipses showed OC-Sensor’s dominance over Hemoccult (sensitivity: 0.47; 95% credibility interval: 0.37–0.58; specificity: 0.93; 95% credibility interval: 0.91–0.95).

Conclusion Our findings support the use of OC-Sensor for CRC detection. The diagnostic estimates obtained may be extended to derive model parameters for economic decision models and to offer insight for future clinical and public health decision making. Our findings could influence the future of FOBTs within the CRC screening arsenal.

aFrench Network for Evaluation in Health Economics, REES-France, Paris

bService d’Hépato-Gastro-entérologie, Hôpital Avicenne APHP, Bobigny, France

Correspondence to Robert Launois, PhD, French Network for Evaluation in Health Economics, REES-France, 28 Rue d’Assas, 75006 Paris, France Tel: +33 1 44 39 16 90; e-mail:

Received April 16, 2014

Accepted June 16, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins