Accuracy and value of the Hemoccult test in symptomatic patients

Hemoccult faecal occult blood testing is widely advocated as a screening test for colorectal cancer but few studies have shown its correlation with conventional methods of investigation for colorectal disease. In a prospective study of 802 symptomatic patients with suspected colorectal disease there was good patient compliance (92.5%) and a high specificity for colorectal cancer (85.4%). The false positive rate was 8.6% (12 of 140 patients with positive results), and while the test result was positive in 22 of 26 colonic cancers the false negative rate for rectal cancer (45.4%) should not detract from its value as a screening test if proper digital anorectal and proctosigmoidoscopic examination are widely practised. A positive Hemoccult test result is a useful indicator for the need to proceed to full colorectal investigation, including colonoscopy.     

Faecal occult blood screening: knowledge, attitudes, and practice in four Hong Kong primary care clinics

OBJECTIVES. To assess primary care patients for their awareness, knowledge, and attitude towards colorectal cancer and screening, to report on the uptake of faecal occult blood test screening and the results of screening, and explore predictors of screening uptake. DESIGN. Cross-sectional study. SETTING. Four primary care clinics in Hong Kong. PATIENTS. A total of 1664 patients aged 50 to 74 years attending the clinics in the period July 2006 to July 2007. MAIN OUTCOME MEASURES. Percentage of subjects who were aware that colorectal cancer is common and curable at an early stage, and who knew that faecal occult blood test or colonoscopy is useful for screening; relevant knowledge score; uptake rate of faecal occult blood testing; rate of testing positive; and factors predicting uptake. RESULTS. A total of 1645 questionnaires were collected. In all, 89% (95% confidence interval, 88-91%) were aware that colorectal cancer is common, 95% (94-96%) believed faecal occult blood test and colonoscopy are useful for screening, and 58% (56-61%) achieved a knowledge score of 50% or above. The uptake rate of the faecal occult blood test was 35%. Uptake was higher among those with a positive family history (odds ratio=1.57; 95% confidence interval, 1.08-2.27; P=0.02), those who were more aware that colorectal cancer is common (1.86; 1.29-2.69; P=0.001), and that colorectal cancer is potentially curable at an early stage (1.76; 1.32-2.36; P=0.0001). Rate of testing positive was 2.1% (95% confidence interval, 0.9-3.3%); no colorectal cancer was detected and the neoplasia detection rate (for cancers and adenomas) was 5.1 per 1000 subjects screened. CONCLUSIONS. Patients were aware that colorectal cancer is common in our community, and faecal occult blood test or colonoscopy is useful for screening. The uptake of screening was low, though relatively higher for those with a positive family history and greater awareness of the high frequency and potential for cure of colorectal cancer. Faecal occult blood test positivity rate was 2.1%, and neoplasia detection rate 5.1 per 1000 screened.     

Immunochemical testing for faecal occult blood in patients with colorectal cancer

Eighty-six stool specimens collected from 36 patients with colorectal cancer were tested for occult blood by chemical and immunochemical methods. There was no dietary restriction. Positive results were obtained in 94% of patients by the immunochemical method when the presence of any positive immunochemical test was taken as a positive result. If greater than 1 mg of haemoglobin per gram of faeces was regarded as positive result, then 75% of patients would have been diagnosed as having occult blood in the stool by means of the immunochemical method. Positivity rates for Hemoccult II and rehydrated Hemoccult II were 53% and 81%, respectively.     

大肠癌ET-1表达及其与肿瘤细胞增殖和微血管形成的关系

目的研究ET-1在大肠腺癌中的表达及其与肿瘤细胞增殖和微血管形成的关系,探讨ET-l在大肠癌发生中的作用机制。方法应用免疫组化SABC法检测41例大肠腺癌及20例大肠腺瘤组织中ET-1表达、PCNA标记指数(PCNALI)及肿瘤微血管密度(MVD),分析ET-1表达与PCNALI以及MVD的关系。结果ET-1主要分布于大肠腺癌细胞胞浆,ET-1阳性表达肿瘤组织基质中血管内皮细胞也有增强表达,而癌旁组织及阴性表达的肿瘤组织基质中血管内皮细胞仅有较弱表达。腺癌的ET-1表达率及强度显著高于腺瘤(P<0.001)。等级相关分析表明,ET-1表达与PCNALI及MVD均密切相关(P<0.001),PCNALI与MvD亦呈正相关(P<0.001)。结论ET-1可能通过促进大肠癌微血管形成来影响肿瘤恶性生长。     

Caspase-3基因在大肠癌、大肠腺瘤中的表达及其与细胞凋亡的关系

目的探讨大肠癌、大肠腺瘤中Caspase-3基因的表达及其与细胞凋亡的关系。方法采用免疫组化S-P法和原位末端标记法分别检测28例大肠癌、10例大肠腺瘤及5例正常大肠黏膜中Caspase-3基因的表达水平及细胞凋亡。结果Caspase-3基因在大肠癌、大肠腺瘤和正常黏膜组织中表达分别为46．4％（13／28）、60．0％（6／10）、80.0％（4／5），三者之间有显著性差异（P〈0．01）。大肠癌、大肠腺瘤中细胞凋亡指数显著高于正常黏膜组织（P〈0．01），凋亡指数与肿瘤的分化程度有关（P〈0．01），与病理类型、Dukes分期无关。大肠癌、大肠腺瘤中Caspase-3基因表达与细胞凋亡指数密切相关，阳性表达的细胞平均凋亡指数明显高于阴性表达的平均凋亡指数（P〈0．01），而正常黏膜组织中二者无显著性差异（P〉0．05）。结论肿瘤早期阶段的细胞凋亡异常和过度增生，可能是大肠癌的发病原因之一，作为细胞凋亡的调控因子，Caspase-3可能在大肠癌的发生发展中起重要作用。     

Familial colorectal cancer and the screening of family members

A case-control study was undertaken of the family histories of colorectal cancer in 128 patients with colorectal cancers and those of 61 patients with colorectal adenomas and matched surgical control patients who were attending a regional surgical service in Western Australia. One family with multiple polyposis of the colon was excluded from the study. A history of colorectal cancer in one or more first-degree relatives was associated with a relative risk of colorectal cancer of 2.5 (95% confidence interval, 0.8 to 8.0), of adenoma of 2.0 (95% confidence interval, 0.5 to 8.0) and of any colorectal neoplasm of 2.3 (95% confidence interval, 0.9 to 5.6). Four patients with colorectal cancer and one patient with colorectal adenoma had more than one first-degree relative with colorectal cancer, whereas no control subject gave this history. The five families that were represented by these cases each showed some other features of non-polyposis familial colorectal cancer. It was estimated that familial factors could explain 60% of colorectal cancer in persons with a family history of the disease in a first-degree relative and 5% of colorectal cancer in the population as a whole. Haemoccult II tests were posted to 629 living first-degree relatives of the patients with colorectal cancers and adenomas; 44% of these relatives returned the completed tests. Four relatives with positive results of tests both before and after dietary restriction were investigated; all four subjects had colorectal adenomas. In addition, one subject had a short segment of ulcerative colitis. A further mailing of Haemoccult II tests one year later gave a 39% response rate; no further cases of colorectal neoplasia were found. One relative developed carcinoma of the caecum 10 months after a negative result in the first round of Haemoccult screening. Persons with two or more first-degree relatives with colorectal cancer, with or without other features of non-polyposis familial colorectal cancer, are at a high risk of the development of colorectal cancer. The comparatively-poor response to an offer of Haemoccult II testing and its known insensitivity and lack of specificity suggest that it is not a satisfactory method of screening these high-risk subjects.     

Survivin在人结直肠腺瘤和腺癌组织中的表达

目的 研究Survivin（SVV）在人结直肠腺瘤和腺癌组织中的表达及意义。方法 采用免疫组织化学方法检测90例结直肠腺瘤、25例结直肠腺瘤伴重度不典型增生和108例结直肠腺癌组织中SVV、P53和Bcl-2的表达情况。结果 SVV在结直肠腺管状腺瘤、绒毛状腺瘤、绒毛腺管状腺瘤等结直肠腺瘤组织中的表达率分别为30％（12／40）、40．9％（9／22）和35．8％（10／28）,3组间差异无显著性（P〉0．05）。SVV在绒毛腺管状腺瘤组织伴重度不典型增生组织,DukesA、B、C期结直肠腺癌组织中的表达率分别为68％（17／25）、75％（27／36）、81．3％（26／32）和95％（38／40）,均明显高于结直肠腺瘤各组（P〈0．05）。P53和Bcl-2在上述各组病例组织中的表达差异均无显著性（P〉0．05）。SVV的高表达与Bcl-2和P53表达无相关性（P=0．487,P=0．437）。结论 SVV在结直肠癌发生早期即有表达异常,可能与结直肠腺瘤癌变具有一定关系。SVV表达对结直肠腺瘤和腺癌的鉴别诊断具有一定意义。     

COX-2在大肠癌组织中的表达及临床意义

目的探讨COX-2在大肠癌组织中的表达及其与生物学行为之间的关系。方法应用免疫组织化学SP法检测51例大肠癌、15例大肠增生性息肉、16例正常大肠黏膜组织的COX-2的表达。结果 COX-2的表达在大肠癌组织与腺瘤组织之间差异无显著性（P〉0.05）,大肠癌、大肠腺瘤中COX-2的阳性表达率明显高于正常肠黏膜组织（P〈0.05）。COX-2在大肠癌组织中的表达与患者性别、年龄、肿瘤大小、肿瘤部位和分化程度无关（P〉0.05）,但与肿瘤Dukes分期、淋巴结转移相关（P〈0.05）。结论 COX-2在大肠癌组织中高表达,在大肠癌发生、发展过程中起重要作用。     

潜血试验对人群大肠病变的普查意义

为验证潜血试验对人群大肠癌普查的筛检效果,在对4337例年龄在35岁以上的人群进行潜血试验的同时,作了全乙状结肠镜和部分全结肠镜检查。结果表明,肠镜病变检出率在非筛选人群为10.1％,在筛选人群中方13.3％,共查出大肠癌10例(含早期大肠癌5例),腺瘤167例,非腺瘤息肉131例,慢性肠炎171例。1％联苯胺试验阳性率为6.0％,检出60％大肠癌及3.9％腺瘤;免疫双扩试验阳性率为3.4％,检出40％大肠癌及2.0％腺瘤;SPA免疫潜血试验阳性率为14.7％,检出80％大肠癌(包括3例早期癌)及42.2％腺瘤。结果提示,潜血试验确能检出一些包括早期大肠癌在内的肠道肿瘤病变,尤以SPA免疫潜血试验敏感性最强。虽然潜血试验存在一定的漏检率(1％联苯胺为40％,免疫双扩为60％,SPA法为20％),但鉴于该法简易、经济,作为大规模大肠癌普查筛检.仍不失为一种值得推广的积极措施。     

维甲类X受体RXRα蛋白在结直肠癌组织中的表达及意义

【目的】探讨RXRα基因蛋白在结直肠癌组织中的表达及其临床意义。【方法】选取结直肠癌标本53例,良性腺瘤标本31例;以正常结直肠粘膜标本37例作为对照组,用免疫组织化学ABC法检测RXRα的表达变化。【结果】RXRα在正常粘膜、良性腺瘤和结直肠癌组阳性表达率分别为89.2%、70.9%和49.1%,与正常粘膜组和良性腺瘤组比较,结直肠癌组RXRα表达率下降,差异有显著性(P<0.05);RXRα蛋白表达与肿瘤分化程度无相关性(P<0.05),而与肿瘤淋巴结转移和临床病理分期密切相关(P<0.05)。【结论】结直肠癌组织中RXRα蛋白表达显著低于良性腺瘤和正常粘膜组织,提示RXRα蛋白在结直肠癌演变中具有重要意义。     

大肠癌P21、CDK4蛋白表达的相关性和临床意义

[目的]探讨大肠癌P2 1、CDK4蛋白表达的临床意义。[方法]采用SP法检测P2 1、CDK4在正常肠黏膜组织、大肠腺瘤和大肠癌中的表达情况。[结果]P2 1阳性表达率在正常黏膜组织、腺瘤与大肠癌中为88.9%、6 6 .7%与4 0 .8% ,肿瘤组织明显低于正常黏膜(P <0 .0 5 ) ;在大肠癌高、中与低分化3组中分别为5 0 .0 %、5 2 .2 %与14 .3% ;DukeA B期(5 2 .4 % )明显高于C D期(32 .1% ) ;淋巴结转移阴性组(5 8.8% )明显高于阳性组(31.3% ) (P <0 .0 5 )。CDK4阳性表达率在正常黏膜、腺瘤与大肠癌中为11.1%、33.3%与5 7.1% ,呈递增趋势(P <0 .0 5 ) ;大肠癌高、中与低分化3组分别为2 5 .0 %、5 6 .5 %与85 .7% ;DukeA B期(38.1% )明显低于C D期(71.4 % ) ;淋巴结转移阴性组(5 2 .9% )与阳性组(5 9.4 % )差异不明显。[结论]P2 1表达减少或缺失和CDK4的表达上调,可作为判定大肠癌恶性程度及预后的有效指标。     

MC_5抗原在大肠良、恶性病变中的表达研究

本文应用 MC_s 抗人大肠癌单克隆抗体,通过 ABC 免疫组化方法,对51例大肠癌、60例大肠息肉、16例慢性炎症性大肠粘膜及20例正常大肠粘膜标本进行 MC_5抗原表达研究,显示大肠癌中 MC_5抗原表达的阳性率为100％;大肠腺瘤中的阳性率为70.73％,且阳性率随腺瘤异型程度的增加而上升;而在炎性及正常粘膜中,MC_s 抗原均未见阳性表达。结果表明 MC_s抗原在大肠正常粘膜、腺瘤和癌肿中有着呈递增趋势阳性表达,支持在肠粘膜正常-异型增生-癌变序列变化理论,证实 MC_s 抗原是一个具有很高特异性和敏感性的大肠癌肿瘤标志物     

Readability and sensitivity of a new faecal occult blood test in a hospital ward environment. Comparison with an established test.

OBJECTIVE: To compare the readability and sensitivity of a new guaiac faecal occult blood test, HemoccultSENSA, with those of a standard guaiac-based test, Hemoccult, in a normal working environment. DESIGN: The two tests were performed in parallel on routine clinical and contrived faecal specimens; those developing the tests were blinded as to the test type. SETTING: All tests were carried out in the hospital ward environment under normal conditions by nurses working in the ward. SAMPLES: Fifty faecal samples from healthy volunteer subjects (low concentrations of haemoglobin were added to 40 of these samples) and 145 faecal samples from 65 inpatients likely to have gastrointestinal bleeding. MAIN OUTCOME MEASURES: Test positivity rate, and graded measures of colour intensity, colour stability and colour pattern. RESULTS: With patients' samples, the new test gave a greater number of positive results than the standard test (73.1% v. 65.5%; 95% confidence interval of the difference, 3.3%-11.9%). With contrived samples, the blue colour produced during development was more intense (P less than 0.0003), more stable (P less than 0.0025) and covered a larger area (P less than 0.01) with the new test compared with the standard test. CONCLUSIONS: These results demonstrate the better readability and slightly higher sensitivity of the new test. They justify its use in the ward environment or doctor's office. Patients being tested should consume a low peroxidase diet until the specificity of the new test has been fully evaluated.     

Influence of non-steroidal anti-inflammatory drugs on the outcome of faecal occult blood tests in screening for colorectal cancer

Non-steroidal anti-inflammatory drugs have been accused of causing false positive results in faecal occult blood tests for colorectal cancer. A study was therefore performed in 10,931 people undergoing faecal occult blood screening tests to assess the effect of these drugs on the predictive value of a positive test result. Those with a positive result were interviewed and a full drug history was taken before they underwent a full colorectal examination. Of the 455 people with a positive result, 50 were taking non-steroidal anti-inflammatory drugs: 10 (20%) had colonic neoplasia. Of the 405 who were not taking non-steroidal anti-inflammatory drugs, 129 (32%) had colonic neoplasia. These detection rates were not significantly different, and the predictive value of a positive result for an adenoma larger than 1 cm was 14% in the group not taking anti-inflammatory drugs and 26% in the group taking them (not significant). These results suggest that a finding of occult faecal blood cannot be attributed to upper gastrointestinal tract bleeding caused by non-steroidal anti-inflammatory drugs and should be followed by a thorough colorectal examination.     

CD44v6在结直肠癌组织中的表达及临床意义

目的 探讨CD44v6表达与结直肠癌发生、发展及转移的关系。方法 采用SP免疫组织化学方法,检测62例原发性结直肠腺癌、45例结直肠腺瘤和17例结直肠正常粘膜中CD44v6的表达情况。结果 结直肠腺瘤和腺癌组织中CD44v6阳性表达率分别为57．8％、77．4％,明显高于正常粘膜的阳性表达率。CD44v6阳性表达与腺癌浸润深度、分化程度无关,但与淋巴结转移相关,淋巴结转移组阳性表达率（87．5％）高于无淋巴结转移组（71．1％）,两组比较有显著性差异（P〈0．001）。结论 CD44v66表达与结直肠癌的发生、发展及转移有一定关系。     

肠镜活检组织中p53蛋白和增殖细胞核抗原表达及其意义

目的 研究肠镜活检标本中Ｐ５３及增殖细胞核抗原（ＰＣＮＡ）的表达及其意义。方法 应用免疫组化ＳＰ检检测１１０例肠知检组织Ｐ５３及ＰＣＮＡ表达,其中２０例大肠癌患者手术切除组织再行Ｐ５３及ＰＣＮＡ染色。结果 正常粘膜Ｐ５３表达阴性。腺及腺癌中Ｐ５３表达率分别为１０％和５１．３％,两者差异有显著性（Ｐ〈０．０５）。腺癌中ＰＣＮＡ强阳性率高于腺瘤组（Ｐ〈０．０５）。腺癌中ＰＣＮＡ强阳性率高于腺瘤组（ＰＣ     

MMP-7和FasL在大肠癌的表达及其相互作用

目的:研究MMP7和FasL在大肠癌的表达及其意义。方法:应用免疫组化SP法检测MMP7和FasL蛋白在正常黏膜、非瘤性息肉、腺瘤和大肠癌等4组不同大肠病变组织中的表达情况,分析其间的相互作用关系。结果:①MMP7蛋白染色阳性率在4组分别为8.3%,10.0%,52.6%和70.4%,后2组显著高于前2组(均P<0.01),并且第4组显著高于第3组(P<0.05);FasL蛋白在4组阳性率分别为:0、10.0%、34.2%和63.6%。大肠癌组中FasL蛋白的表达阳性率显著高于前3组(均P<0.01)。②MMP7和FasL蛋白在大肠癌的表达与患者的性别、年龄、部位无明显相关性(P>0.05),随着分化程度的降低有增加趋势(P<0.05),在淋巴结有转移组、Duke’s分期C期及以上组分别高于淋巴结无转移组、Duke’s分期A、B期组(P<0.05)。③MMP7蛋白阳性表达与FasL蛋白阳性表达正相关(P<0.01)。结论:MMP7与FasL在腺瘤和大肠癌均有高表达,在大肠癌的发病过程中,它们的共同高表达具有协同效应,共同促进大肠癌的发生和发展。     

c－myc基因表达水平是评价大肠腺瘤恶变倾向的一个临床实用的指标

本文作者利用Ｎｏｒｔｈｅｒｎ印迹杂交、斑点杂交技术，比较了大肠癌、腺瘤（癌前期病变）与正常粘膜组织中ｃ－ｍｙｃ基因的表达水平。实验结果表明：在大多数结肠癌（１４／１７）和一部分腺瘤（直径＞１ｃｍ）中ｃ－ｍｙｃ基因的表达水平显著增高，而另一部分小腺瘤（直径（１ｃｍ）中仅有轻度增高。我们认为：ｃ－ｍｙｃ基因的表达水平对于判断大肠腺瘤是否恶变是一个具有潜在临床应用价值的指标。     

整合素连接激酶在结肠癌中的表达情况

目的:探讨整合素连接激酶(ILK)在结肠癌的发生发展中的作用。方法:采用免疫组织化学方法对84例结肠肿瘤中ILK的表达进行检测。结果:ILK在正常结肠黏膜阴性表达;在结肠腺瘤中75%表达;结肠原位癌中83.3%;在浸润性结肠癌中100%表达。ILK在结肠浸润性癌与原位癌表达差异有统计学意义,在不同分级、分期、浸润深度、淋巴结转移比较,差异有统计学意义(P<0.05)。结论:ILK在结肠肿瘤的进展、侵袭、转移上都有着重要的意义,可以作为结肠癌的预后指标。