Immunochemical vs guaiac faecal occult blood tests in a population-based screening programme for colorectal cancer.

Two faecal occult blood tests (FOBTs), Hemoccult II (guaiac based) and Hemeselect (immunochemical) were compared in a population screening for colorectal cancer on 24 282 subjects aged 40-70. Hemeselect was interpreted according to a lower (+ and +/-) and a higher (+) positivity threshold. A total of 8008 compliers were enrolled in the study. Positivity rates: Hemoccult = 6.0%, Hemeselect (+ and +/) = 8.2%, Hemeselect (+) = 3.1%. Among FOBT-positive subject complying with the diagnostic work-up, 22 had colorectal cancer (17 Hemeselect-positive (+), four Hemeselect-borderline (+/-), 15 Hemoccult-positive) and 166 subjects had adenomas (62 Hemeselect(+), 56 Hemeselect-borderline (+/-), 79 Hemoccult-positive) were detected. The positive predictive values (PPVs) for cancer were as follows: Hemoccult = 3.7%, Hemeselect (+ and +/-) = 3.8%, Hemeselect (+) = 8.4%. The PPVs for adenoma(s) were: Hemoccult = 19.7%, Hemeselect (+ and +/-) = 21.4%, Hemeselect (+) = 30.5%. The specificity for cancer was: Hemoccult = 94.1%, Hemeselect (+ +/-) = 92%, Hemeselect (+) = 97.1%. Ratios between detection rates of each test and expected incidence of colorectal cancer suggest that Hemoccult anticipates cancer diagnosis by approximately 2 years on average whereas the mean diagnostic anticipation of Hemeselect ranges between 2.5 and 3.2 years. Hemeselect is superior to Hemoccult as it is at least as effective but more efficient and acceptable than guaiac testing. Further evaluation of Hemeselect cost-effectiveness and sensitivity is needed in order to assess the optimal threshold of positivity and screening frequency.     

Immunological detection of faecal occult blood in colorectal cancer

A new two-phase test kit for faecal occult blood combining a sensitive guaiac test (Fecatwin (S)ensitive) with an immunological test for human haemoglobin (FECA-EIA) was compared with three current guaiac tests (Fecatest, Fecatwin, Haemoccult) in 19 colorectal cancer patients and 11 controls on a restricted diet. A total of 43 48 h faecal samples (30 from cancer patients and 13 from controls) were collected for quantitative determination of faecal blood loss with the 51Cr method. Qualitative testing revealed that FECA-EIA was the most sensitive test, giving one (3%) false negative test result in the 30 tests on colorectal cancer patients and no false positives in the control subjects. It was also the only test that detected low-degree tumour bleeding. Fecatest and Fecatwin S were the most sensitive guaiac tests, giving 7 and 10% false negative test results, respectively, in the 30 colorectal cancer samples, whereas Haemoccult and Fecatwin gave 23% false negative test results. For screening purposes and in order to reduce costs it is suggested that only the positive test results of the very sensitive guaiac test (Fecatwin S) should be tested with the FECA-EIA test to eliminate false positive results. With this approach the diagnostic accuracy of the new two-phase test will be about twice as good as for the Haemoccult test.     

Comparative screening with a sensitive guaiac and specific immunochemical occult blood test in an endoscopic study

BACKGROUND: HemoccultSENSA (HOS), the sensitive guaiac fecal occult blood test (FOBT) for colorectal neoplasia, is faulted for its low specificity, which might be improved by substituting or adding FlexSure OBT (FS), the immunochemical test for human hemoglobin. (Both tests are manufactured by Beckman-Coulter Inc., Primary Care Diagnostics, Palo Alto, CA.) The authors compared both FOBTs in an endoscopic study to determine which FOBT to recommend for a population-screening program. METHODS: Both FOBTs, without dietary restrictions, were prepared by 1410 screenees or nonbleeding symptomatic patients (3%). All underwent colonoscopy (51.8%) or flexible sigmoidoscopy (if asymptomatic and both FOBTs were negative). RESULTS: HOS sensitivity for significant neoplasia, cancers, or adenomas >/= 1 cm (20 cases) was similar to that of FS (50% vs. 35%, not significant). However, HOS specificity was lower (95% vs. 99%, confidence interval (CIs) 94-96 vs. 98-99, P < 0.05). In those 11 cases in which both HOS and FS were positive, specificity for significant neoplasia was 100% but sensitivity decreased to 25% (less than HOS alone, P < 0.05). HOS was more sensitive than FS for any neoplasia (55 cases), including adenomas < 1 cm (35% vs. 18%, CIs 22-47 vs. 8-28, P < 0.05), but less specific (96% vs. 99%, CIs 95-97 vs. 98-100, P < 0.05). CONCLUSIONS: Guaiac HOS, which does not require dietary restrictions, is significantly more sensitive for any colorectal neoplasm than the immunochemical FS; it identifies more adenomas with a specificity that is low but acceptable for population screening.     

Fecal Adnab-9 binding as a risk marker for colorectal neoplasia

Adnab-9 binding in colonic tissue and effluent has been associated with an increased risk for colorectal neoplasia. We investigated if fecal binding by Adnab-9 may be used as a marker for colorectal neoplasia. A fecal-Adnab-9 ELISA was performed on samples of 249 patients and colonoscopic pathology results correlated. Fecal Adnab-9 binding was seen in 63% of patients with colorectal neoplasia (59% with colorectal cancer and 83% with adenoma), 33% with inflammatory bowel disease, 0% with hyperplastic polyps and 10% of controls. We conclude that fecal Adnab-9 binding is a promising risk marker for colorectal neoplasia.     

A comparison of an immunological faecal occult blood test Fecatwin sensitive/FECA EIA with Haemoccult in population screening for colorectal cancer

Two faecal occult blood tests, a simple chemical test Haemoccult and an immunological test, Fecatwin Sensitive/Feca EIA, were offered to 3,225 asymptomatic individuals as screening for colorectal cancer. One thousand three hundred and four (44%) completed and returned the tests and of these 126 (9.7%) were found to be positive - Haemoccult 40 (3%) and Feca EIA 106 (8.1%). Five cancers (4 Dukes' Stage A, 1 Dukes' Stage C) and 23 adenomas greater than 1 cm were detected - rates of 3.8 per 1000 persons screened and 17.7 per 1000 persons screened respectively. Of the five cancers identified 5 were Feca EIA positive and 3 were Haemoccult positive. Of the 23 adenomas greater than 1 cm diameter identified, J1 were Feca EIA positive and 20 were Haemoccult positive. Seventy-eight Feca EIA positive subjects were investigated and no neoplastic disease was identified. Whilst this sensitive immunological test increases the yield of carcinomas, the high false positive rate makes it unsuitable for population screening for colorectal cancer in its present form.     

The value of colonoscopic surveillance following a diagnosis of colorectal cancer or adenomatous polyp

Conventional follow-up of patients with colonic neoplasia will at best only identify symptomatic lesions and those visible with a sigmoidoscope, and will therefore fail to identify new malignant lesions in time for effective treatment. In 1980 we began a prospective study of the efficacy and feasibility of replacing conventional outpatient follow-up with annual colonoscopic surveillance. One hundred and fifty-eight patients, attending one surgeon, have been entered: 74 patients who had a curative resection for colorectal carcinoma and 84 patients who had endoscopic or local resection of an adenoma. In the carcinoma group (mean follow-up 4.3 years, range 1-21), 40 of 237 colonoscopies were positive (17%) in 27 patients (36%). Forty-eight polyps were removed endoscopically and two asymptomatic recurrent carcinomas identified. In the adenomatous polyp group (mean follow-up 4 years, range 1-11), 40 of 252 colonoscopies were positive (16%) in 29 patients (34%). Fifty polyps were removed endoscopically, including two which had become malignant. All patients were also screened by Haemoccult stool testing, in the hope that it would identify these lesions and allow the frequency of colonoscopy to be reduced. Unfortunately, Haemoccult testing failed to identify many lesions, including one carcinoma and one malignant polyp. Our experience suggests that colonoscopic follow-up of all patients with colonic neoplasia attending one surgeon is a feasible exercise which can and should replace outpatient appointments for clinical examination.     

Detection of colorectal neoplasia with peanut-agglutinin(PNA)-reactive carbohydrate structures in rectal mucus

In contrast to normal colorectal mucosa, peanut-agglutinin(PNA)-reactive glycoconjugates are commonly expressed in most colorectal carcinomas and in some pre-malignant conditions such as adenomas and ulcerative colitis. Since enzymatically detectable galactose-β1-3-N-acetyl-galactosamine residues are found in rectal mucus obtained from patients with carcinoma of the large bowel, it was investigated here whether PNA-reactive carbohydrate structures in rectal mucus can be exploited in the detection of colorectal neoplasia. Samples of rectal mucus obtained from 261 randomly selected patients with colorectal symptoms were applied on nitrocellulose filters. The presence of PNA-reactive glycoconjugates in mucus samples was determined by a peroxidase-conjugated PNA-overlay procedure. The results were correlated to findings from total colonoscopy/surgery and histopathology. PNA-reactive carbohydrate structures were detected in 76% of patients with carcinoma (p < 0.005), in 62% of patients with adenoma (p < 0.005), in 69% of patients with inflammatory bowel disease (p < 0.005), and in 38% of patients with hyperplastic polyps (NS), in contrast to 21% of the control subjects with macroscopically normal colorectal mucosa. These results show that PNA-reactive carbohydrate alterations in rectal mucus correlates with neoplastic and hyperproliferative conditions of the colorectal mucosa. The specificity of the PNA test for colorectal neoplasia was 76%. Therefore the use of more discriminate carbohydrate probes are needed for the pre-symptomatic detection of colorectal neoplasia. Int. J. Cancer 74:648–653, 1997.© 1997 Wiley-Liss, Inc.     

Haemoccult test properties according to type and number of positive slides in mass screening for colorectal cancer.

Despite encouraging results from recent studies, there is still no consensus to undertake mass screening using the Haemoccult test in the general population. The success of mass screening for colorectal cancer depends among other things on Haemoccult test properties. In on-going screening programmes, the Haemoccult test consists of six slides and a test is considered positive if at least one slide is coloured. The aim of this work was to study the influence of the type and number of positive slides on the Haemoccult test''s positive predictive value and characteristics of screened lesions. This work focuses on 63,958 first tests in a mass screening programme in Calvados (France) among people aged 45-74 years. There was a linear relation between the positive predictive value for cancer or an adenoma larger than 1 cm and the number of positive slides (P < 10(-4)). The positive predictive value for cancer or large adenoma was significantly higher when 4-6 slides were positive (44.3%) than when only 1-3 were positive (19.1%) (P < 10(-4)). In this latter group, the subjects in whom tumours were detected were younger and had significantly less extensive cancers. Borderline tests (no slides positive and at least one slide with a blue coloration confined to the edges) had a positive predictive value for cancer or an adenoma larger than 1 cm no different to that of tests with 1-3 positive slides. Subjects with borderline results were markedly younger than the others and had less extensive cancers and rectal localisation more often than the others. Our results suggest that (1) increasing the number of positive slides required to declare a test positive leads to an increase in the positive predictive value but is not to be recommended because of the sensitivity of the test and (2) considering borderline Haemoccult tests as positive in on-going and future mass screening campaigns would allow an increase in the sensitivity of the test, especially for rectal cancer and low extensive tumours without any decrease in its positive predictive value.     

Cancer associated antigen CA19-9 in colonic effluent of patients with neoplasia of the colon and inflammatory bowel disease

We measured colonic effluent samples from 10 patients with colorectal cancer, 13 with adenomatous polyps, 14 with normal colons and compared them to 10 patients with inflammatory bowel disease by measuring this CA19-9 content. Results showed considerable overlap between the different pathologic categories, making differentiation impossible. A lower level of CA19-9 in the effluent samples from patients with adenomas was noted. These differences were reproducible for assays performed several months apart. CA19-9 may originate from the upper gastrointestinal tract since large amounts are present in pancreatico-biliary secretions. This antigen is therefore not useful in the diagnosis of neoplasia or inflammatory bowel disease using colonic effluent samples as the test material.     

Evaluation of an automated immunochemical fecal occult blood test for colorectal neoplasia detection in a Chinese population

BACKGROUND: Most commercial fecal occult blood tests (FOBT) used for colorectal carcinoma screening of Western populations are guaiac-based, manually developed, subjective, and sensitive to dietary components. Preliminary studies demonstrated the unsuitability of these tests for screening a Chinese population. The goal of the current study was to evaluate the performance characteristics of a human hemoglobin-specific automated immunochemical FOBT, the Magstream 1000/Hem SP (Fujirebio, Inc., Tokyo, Japan), in a Chinese population referred for colonoscopy. METHODS: Two hundred fifty consecutive patients who were referred for colonoscopy and met the study inclusion criteria provided samples for the immunochemical FOBT (without dietary restrictions) from two successive stool specimens. Tests were developed with an automated instrument that had an adjustable sensitivity threshold. The sensitivity, specificity, and positive predictive value for detecting colorectal adenomas and carcinomas were calculated according to the manufacturer's instructions over a range of sensitivity levels. RESULTS: At the optimal threshold level, the sensitivity, specificity, and positive predictive value for detection of significant colorectal neoplasia (adenomas >or= 1.0 cm and carcinomas) were 62%, 93%, and 44%, respectively. The test was easy to use, and results did not depend on operator experience. CONCLUSIONS: The automated immunochemical FOBT used in the current study was a robust, convenient, and useful tool for colorectal carcinoma screening in the study population.     

Advantage of immunochemical fecal occult blood test in screening for colorectal cancer

Colorectal cancer screening is a high public health priority in all industrialized countries. However, the low sensitivity of the common guaiac screening test (Haemoccult II) makes practitioners and public health deciders reluctant to set up national screening program. In recent years, immunochemical tests based on the use of a specific antibody have been found to be more sensitive than the Haemoccult II test. However, for screening purposes, any gain in sensitivity is of interest only if specificity and positive predictive value are satisfactory. As instance, rehydration of the Haemoccult II test prior to lecture can increase sensitivity, but the associated decrease in specificity and positivity predictive value and the high positivity rate render its value in mass screening debatable. Moreover, extra costs, if existing, must be acceptable for the society. Until recently, immunochemical tests costs made it unaffordable in our societies. The arrival of automated reading is likely to remove this obstacle. Moreover it offers the opportunity of positivity cut-off choice. A recent study was conducted in Cotentin (France) to assess the performance of an immunochemical test with an automated reading technique (Magstream 1000) for different haemoglobin content cut-off points. As previous American, Japanese, Chinese and Italian studies, this study suggests that the use of immunochemical tests could lead a substantial gain, in screening sensitivity. Moreover by choosing a higher haemoglobin content as cut-off point (50 ng/ml instead of usual cut-off at 20 ng/ml), a gain in sensitivity can be obtained with a satisfactory specificity (97%) and positivity rate (3%). Considering the increasing number of publications, the use of an immunochemical test with an automated reading technique could improve the prospects for mass-screening for colorectal cancer, since it offers a promising alternative to guaiac tests.     

Comparison of a brush-sampling fecal immunochemical test for hemoglobin with a sensitive guaiac-based fecal occult blood test in detection of colorectal neoplasia

BACKGROUND: Fecal immunochemical tests (FIT) are an advanced fecal occult blood test (FOBT) technology that reduces barriers to population screening by simplifying the logistics of stool-sampling. The current study was conducted to undertake a paired comparison of a sensitive guaiac FOBT (GFOBT; Hemoccult II Sensa, Beckman Coulter, Fullerton, CA) with a brush-sampling FIT (InSure; Enterix, North Ryde, NSW, Australia), to determine whether this FIT improves detection of significant neoplasia. METHODS: Individuals sampled consecutive stools, at home, with both FIT and GFOBT sampling devices while following dietary restrictions appropriate for GFOBT. Study populations included a screening cohort (n = 2351) and a symptomatic diagnostic group (n = 161). Paired comparison of positivity rates was undertaken in those found to have cancer and/or significant adenoma (high-grade dysplasia, villous change, > or =10 mm, serrated histology or > or =3 polyps), benign pathology, or no pathology. RESULTS: Combined results for both cohorts showed that the FIT returned a true-positive result significantly more often in cancer (n = 24; 87.5% vs. 54.2%) and in significant adenomas (n = 61; 42.6% vs. 23.0%). Of all UICC Stage I cancers, the FIT was positive in 12 of 13 compared with 4 of 13 with the GFOBT (P = .002). In analyses of just the screening cohort, the FIT remained significantly better at detecting cancers and significant adenomas; the false-positive rate for any neoplasia was marginally higher with the FIT than the GFOBT (3.4% vs. 2.5%; 95% CI of difference, 0-1.8%), whereas positive predictive values were 41.9% and 40.4%, respectively. CONCLUSIONS: This brush-sampling FIT is more sensitive for cancers and significant adenomas than a sensitive GFOBT. As such, it should deliver greater reductions in colorectal cancer mortality and incidence than the GFOBT.     

Congenital hypertrophy of the retinal pigment epithelium and mandibular osteomata as markers in familial colorectal cancer.

Congenital hypertrophy of the retinal pigment epithelium (CHRPE) and multiple mandibular osteomata are markers of familial adenomatous polyposis (FAP). We have assessed their prevalence in non-polyposis familial colorectal neoplasia. Multiple mandibular osteomata were present in 1/29 (3%) patients with familial colorectal neoplasia. CHRPE was present in 11/33 (33%) patients with familial colorectal neoplasia compared with 3/36 (8%) with sporadic disease (P = 0.01) and 4/32 (12.5%) control subjects (P = 0.04). Seven patients with familial colorectal neoplasia had multiple areas of CHRPE compared with one with sporadic disease (P = 0.02) and one control subject (P = 0.02). There was no obvious correlation between calculated familial colorectal cancer risk and the presence of multiple areas of CHRPE. A proportion of patients with familial colorectal cancer have a marker found in FAP and may therefore have a constitutional genetic defect, at least in part responsible for their cancer, making them an interesting group for genetic study. Ophthalmoscopy may contribute to risk assessment in familial colorectal cancer.     

Serum M2-pyruvate kinase: A promising non-invasive biomarker for colorectal cancer mass screening

AIM: To explore the value of serum M2-pyruvate kinase (M2-PK) in colorectal cancer (CRC) mass screening. METHODS: We conducted a molecular epidemiology study in Hangzhou, China, from year 2006 to year 2008. Serum samples were collected from 93 CRC, 41 advanced adenomas, 137 adenomas, 47 non-adenomatous polyps, and 158 normal participants in a community setting. Serum M2-PK and carcinoembryonic antigen (CEA) were measured using Enzyme-linked immuno-sorbent assay. SPSS 16.0 software was used to perform data analysis. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificities were estimated for serum M2-PK in diagnosis of colorectal lesions and compared with CEA. RESULTS: Average serum M2-PK value among 158 normal people was 2.96 U/mL and not affected by gender (P = 0.47) or age (P = 0.59). Average serum M2-PK (U/mL) was 14.75 among stage Ⅲ and 13.10 among stage Ⅰ and Ⅱ CRC patients, about 4 times higher than that among normal people. Average serum M2-PK was 8.58, 6.70, 5.13 and 2.51 U/mL among advanced adenoma, adenomas, non-adenomatous polyps, and inflammatory bowel disease patients, respectively. AUC for serum M2-PK was greater than that for CEA among all colorectal lesions. AUC for serum M2-PK was 0.89 (0.84, 0.94) (95% confidence interval), higher than that for CEA [0.70 (0.62-0.79)] in CRC stageⅠ and Ⅱ, 0.89 (0.84-0.94) vs 0.73 (0.63-0.83) in CRC stage Ⅲ, 0.81 (0.74-0.86) vs 0.63 (0.53 -0.73) in advanced adeno- mas, 0.69 (0.64-0.76) vs 0.54 (0.47-0.60) in adenomas, and 0.69 (0.62-0.78) vs 0.58 (0.48-0.68) in nonadenomatous polyps. The diagnostic sensitivity for all colorectal lesions increased with decrease in the cut-off value of serum M2-PK. The diagnostic sensitivity (%) of serum M2-PK was 100.00 for CRC, 95.12 advanced ad- enoma, 82.48 adenoma, and 82.98 non-adenomatous polyp. There were no CRC cases missed and 40.51% of unnecessary colonoscopies were avoided when the cut-off value was 2.00 U/mL. CONCLUSION: Serum M2-PK can be used as a primary screening test in CRC mass screening. It may be a promising non-invasive biomarker for CRC early detection.     

中性粒细胞/淋巴细胞比值在大肠癌癌变进展中的指示价值

目的 探讨中性粒细胞/淋巴细胞比值(Neutrophil to lymphocyte ratio,NLR)在大肠癌癌变进展中的指示价值。方法 选取安徽医科大学附属合肥医院收治大肠癌患者51例,腺瘤性息肉63例,炎性、增生性息肉75例以及正常对照组60例,同时随机选取其他消化系统恶性肿瘤48例和炎症性肠病患者21例;比较六组患者以及不同分期的大肠癌患者NLR、CEA、CA199水平差异;以ROC曲线的方法计算NLR升高的临界值和曲线下面积(AUC),比较NLR、CEA和CA199在大肠癌筛查中的效率差异。结果 大肠癌组NLR水平明显高于腺瘤组、息肉组、正常对照组以及其他肿瘤和炎症性肠病组,差异具有统计学意义(P＜0.05),其他肿瘤和炎症性肠病组NLR水平较高,但与腺瘤组、息肉组、正常对照组之间差异无统计学意义(P＞0.05);Dukes A期、Dukes B期患者NLR水平低于Dukes C期、Dukes D期患者,差异具有统计学意义(P＜0.05)。NLR最佳临界值为2.73,AUC=0.727,具有较准确的诊断价值;NLR、CEA、CA199筛查大肠癌的灵敏度依次为:NLR＞CEA＞CA199,特异度CA199＞CEA＞NLR;三项指标联合检测时灵敏度和特异度可达81.62%和95.08%,高于单用和任意两指标联用时的筛查价值。结论 NLR升高对大肠癌患者体内高炎症反应状态有一定指示意义,在运用到大肠癌筛查时,其灵敏度优于传统肿瘤标记物,但特异性较差,故建议临床上与其他肿瘤标记物联合检查,提高筛查的准确性。     

The relative value of fecal occult blood tests and flexible sigmoidoscopy in screening for large bowel neoplasia

The secondary prevention of colorectal cancer is based on the early detection of noninvasive cancer and removal of adenomatous polyps. The two commonly used screening tests are flexible sigmoidoscopy and guaiac fecal occult blood testing. Both were performed simultaneously and independently on 1176 asymptomatic volunteers followed by colonoscopic examination if either occult blood or a neoplasm was detected. Neoplasia (adenomatous polyps or cancer) were found in 48 screenees. Only ten had positive stool occult blood while 45 were detected by sigmoidoscopy. Analysis of sensitivity for neoplasia was 93.8% for sigmoidoscopy but only 20.8% for the occult blood tests, while the positive predictive values for neoplasia were 100% and 23.8% respectively. The fecal occult blood test detected only 18% of screenees with adenomas and 60% with invasive cancer. Flexible sigmoidoscopy detected 95% and 80% respectively. Analysis (kappa statistic) demonstrated little agreement between the two tests (P greater than 0.05), indicating that they are diagnosing different neoplasia. Evaluation of expected gain in diagnosing neoplasia, by combining both tests, gave 18% for the fecal blood test and 94% for the endoscopic test. These results confirm the complementary value of performing both tests, but especially the high sensitivity and predictive value positive of flexible sigmoidoscopy for adenomas, including those with severe dysplasia, and the converse for the fecal occult blood test. This latter test must be recommended and used within a screening program with caution and full understanding of its limitations.     

Circulating levels of inflammatory cytokines and risk of colorectal adenomas

The association between obesity and colorectal neoplasia may be mediated by inflammation. Circulating levels of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) are elevated in the obese. Adipose tissue can produce and release the inflammatory cytokines that are potentially procarcinogenic. We examined circulating levels of CRP, IL-6, and TNF-alpha in relation to risk factors and the prevalence of colorectal adenomas. Plasma levels of CRP, IL-6, and TNF-alpha were quantified in 873 participants (242 colorectal adenoma cases and 631 controls) in a colonoscopy-based cross-sectional study conducted between 1998 and 2002. Multivariable logistic regression was used to estimate associations between known risk factors for colorectal neoplasia and circulating levels of inflammatory cytokines and associations between inflammatory cytokines and colorectal adenomas. Several known risk factors for colorectal neoplasia were associated with higher levels of inflammatory cytokines, including older age, current smoking, and increasing adiposity. The prevalence of colorectal adenomas was associated with higher concentrations of IL-6 and TNF-alpha and, to a lesser degree, with CRP. For IL-6, adjusted odds ratios (OR) for colorectal adenomas were 1.79 [95% confidence interval (CI), 1.19-2.69] for the second highest plasma level and 1.85 (95% CI, 1.24-2.75) for the highest level compared with the reference level. A similar association was found with TNF-alpha, with adjusted ORs of 1.56 (95% CI, 1.03-2.36) and 1.66 (95% CI, 1.10-2.52), respectively. Our findings indicate that systemic inflammation might be involved in the early development of colorectal neoplasia.     

Haemoccult testing as an indicator of recurrent colorectal cancer: a 5-year prospective study

A prospective study was conducted to assess the value of routine haemoccult testing as an indicator of early luminal recurrence of colorectal cancer. One hundred patients (mean age 72 years) undergoing radical resection (70% Dukes' B and 30% Dukes' C) for colorectal carcinoma were asked to provide 3-monthly haemoccult tests to a special follow-up clinic for a minimum of 5 years. Positive tests underwent further investigation with barium enema and colonoscopy. Patient compliance was 84%. Positive tests were obtained in 14 asymptomatic individuals, five of whom proved to have anastomotic recurrence. Recurrence was also identified in a further patient despite a negative haemoccult test. Three patients with anastomotic recurrence were able to undergo further radical surgery; two were still alive over 5 years after detection of recurrent disease. Haemoccult screening appears to detect increased numbers of patients with luminal recurrence (7.2%) when compared to historical controls (2.1%). Larger studies will be needed to determine if this increased detection rate results in improved long-term survival.     

Effectiveness of complete diagnostic examination in clinical practice settings

BACKGROUND: Thorough follow-up of a positive fecal occult blood test (FOBT) result, or a complete diagnostic evaluation (CDE), is recommended as routine care on the basis of findings from colorectal cancer (CRC) screening trials. CDE involves either colonoscopy or the combination of flexible sigmoidoscopy and double contrast barium enema X-ray. However, little evidence outside clinical screening trial settings has been reported in the literature to support CDE performance. The focus of this study was to determine the impact of CDE in primary care practice settings. METHODS: We determined diagnostic outcomes for 461 adult patients with a positive FOBT result in 318 primary care practices in southeastern Pennsylvania and southern New Jersey. Sociodemographic data were collected and CDE status was ascertained for these patients. Polytomous logistic models were used to identify whether having CDE was associated with subsequently being diagnosed with lower gastrointestinal "neoplastic disease" or "other gastrointestinal disease" as compared to "normal findings. RESULTS: Patients who underwent CDE were significantly more likely to have a reported diagnosis of colorectal neoplasia than normal findings (adjusted odds ratio = 3.65, 95% confidence interval = 1.58-8.39, p = 0.02). CDE performance did not result in the differential diagnosis of other gastrointestinal disease. CONCLUSIONS: Patients with a positive screening FOBT who underwent CDE were more likely to be diagnosed with colorectal neoplasia than with less serious conditions or have normal findings. Results support the use of CDE in CRC screening.