Effectiveness of colonoscopy,immune fecal occult blood testing,and risk-graded screening strategies in colorectal cancer screening

BACKGROUND Colorectal cancer(CRC)is one of the most common malignant tumors,and early screening is crucial to improving the survival rate of patients.The combination of colonoscopy and immune fecal occult blood detection has garnered significant attention as a novel method for CRC screening.Colonoscopy and fecal occult blood tests,when combined,can improve screening accuracy and early detection rates,thereby facilitating early intervention and treatment.However,certain risks and costs accompany it,making the establishment of a risk classification model crucial for accurate classification and management of screened subjects.AIM To evaluate the feasibility and effectiveness of colonoscopy,immune fecal occult blood test(FIT),and risk-graded screening strategies in CRC screening.METHODS Based on the randomized controlled trial of CRC screening in the population conducted by our hospital May 2020 to May 2023,participants who met the requirements were randomly assigned to a colonoscopy group,an FIT group,or a graded screening group at a ratio of 1:2:2(after risk assessment,the high-risk group received colonoscopy,the low-risk group received an FIT test,and the FITpositive group received colonoscopy).The three groups received CRC screening with different protocols,among which the colonoscopy group only received baseline screening,and the FIT group and the graded screening group received annual follow-up screening based on baseline screening.The primary outcome was the detection rate of advanced tumors,including CRC and advanced adenoma.The population participation rate,advanced tumor detection rate,and colonoscopy load of the three screening programs were compared.RESULTS A total of 19373 subjects who met the inclusion and exclusion criteria were enrolled,including 8082 males(41.7%)and 11291 females(58.3%).The mean age was 60.05±6.5 years.Among them,3883 patients were enrolled in the colonoscopy group,7793 in the FIT group,and 7697 in the graded screening group.Two rounds of follow-up screening were completed in the FIT group and the graded screening group.The graded screening group(89.2%)and the colonoscopy group(42.3%)had the lowest overall screening participation rates,while the FIT group had the highest(99.3%).The results of the intentional analysis showed that the detection rate of advanced tumors in the colonoscopy group was greater than that of the FIT group[2.76%vs 2.17%,odds ratio(OR)=1.30,95%confidence interval(CI):1.01-1.65,P=0.037].There was no significant difference in the detection rate of advanced tumors between the colonoscopy group and the graded screening group(2.76%vs 2.35%,OR=1.9,95%CI:0.93-1.51,P=0.156),as well as between the graded screening group and the FIT group(2.35%vs 2.17%,OR=1.09%,95%CI:0.88-1.34,P=0.440).The number of colonoscopy examinations required for each patient with advanced tumors was used as an index to evaluate the colonoscopy load during population screening.The graded screening group had the highest colonoscopy load(15.4 times),followed by the colonoscopy group(10.2 times),and the FIT group had the lowest(7.8 times).CONCLUSION A hierarchical screening strategy based on CRC risk assessment is feasible for screening for CRC in the population.It can be used as an effective supplement to traditional colonoscopy and FIT screening programs.

Evaluating the Efficacy of Fecal Occult Blood Test and Tumor Marker Combined Screening for Colorectal Cancer

Objective:To analyze the screening effectiveness of combining the fecal occult blood test with tumor marker detection for colorectal cancer.Methods:A total of thirty patients with colorectal cancer and thirty patients with benign colon hyperplasia who received treatment from January 2020 to January 2023 were selected.These patients were assigned to the observation group and the control group,respectively.All patients in both groups underwent both fecal occult blood tests and tumor marker detection.The levels of tumor markers between the two groups were compared,the tumor marker levels in different stages were assessed within the observation group,and the positive detection rates for single detection and combined detection were compared.Results:The levels of various tumor markers in the observation group were significantly higher than those in the control group(P<0.05).Furthermore,as the Duke stage increased within the observation group,the levels of various tumor markers also increased(P<0.05).The positive detection rate of the combined test was notably higher than that of single detection(P<0.05).Conclusion:Combining the fecal occult blood test with tumor marker detection in colorectal cancer screening can significantly improve the overall detection rate.

Impact of fecal occult blood on obscure gastrointestinal bleeding:Observational study

AIM: To elucidate the association between small bowel diseases(SBDs) and positive fecal occult blood test(FOBT) in patients with obscure gastrointestinal bleeding(OGIB).METHODS: Between February 2008 and August 2013, 202 patients with OGIB who performed both capsule endoscopy(CE) and FOBT were enrolled(mean age; 63.6 ± 14.0 years, 118 males, 96 previous overt bleeding, 106 with occult bleeding). All patients underwent immunochemical FOBTs twice prior to CE. Three experienced endoscopists independently reviewed CE videos. All reviews and consensus meeting were conducted without any information on FOBT results. The prevalence of SBDs was compared between patients with positive and negative FOBT.RESULTS: CE revealed SBDs in 72 patients(36%). FOBT was positive in 100 patients(50%) and negative in 102(50%). The prevalence of SBDs was significantly higher in patients with positive FOBT than those with negative FOBT(46% vs 25%, P = 0.002). In particular, among patients with occult OGIB, the prevalence of SBDs was higher in positive FOBT group than negative FOBT group(45% vs 18%, P = 0.002). On the other hand, among patients with previous overt OGIB, there was no significant difference in the prevalence of SBDs between positive and negative FOBT group(47% vs 33%, P = 0.18). In disease specific analysis among patients with occult OGIB, the prevalence of ulcer and tumor were higher in positive FOBT group than negative FOBT group. In multivariate analysis, only positive FOBT was a predictive factors of SBDs in patients with OGIB(OR = 2.5, 95%CI: 1.4-4.6, P = 0.003). Furthermore, the trend was evidentam on g patients with occult OGIB who underwent FOBT on the same day or a day before CE. The prevalence of SBDs in positive vs negative FOBT group were 54% vs 13% in patients with occult OGIB who underwent FOBT on the same day or the day before CE(P = 0.001), while there was no significant difference between positive and negative FOBT group in those who underwent FOBT two or more days before CE(43% vs 25%, P = 0.20).CONCLUSION: The present study suggests that positive FOBT may be useful for predicting SBDs in patients with occult OGIB. Positive FOBT indicates higher likelihood of ulcers or tumors in patients with occult OGIB. Undergoing CE within a day after FOBT achieved a higher diagnostic yield for patients with occult OGIB.

Prediction of flare-ups of ulcerative colitis using quantitative immunochemical fecal occult blood test

AIM:To examine the feasibility of predicting the flareup of ulcerative colitis (UC) before symptoms emerge using the immunochemical fecal occult blood test (IFOBT).METHODS:We prospectively measured fecal hemoglobin concentrations in 78 UC patients using the I-FOBT every 1 or 2 mo.RESULTS:During a 20 mo-period,823 fecal samples from 78 patients were submitted.The median concentration of fecal hemoglobin was 41 ng/mL (range:0-392 500 ng/mL).There were three types of patients with regard to the correlation between I-FOBT and patient symptoms;the synchronous transition type with symptoms (44 patients),the unrelated type withsymptoms (19 patients),and the flare-up predictive type (15 patients).In patients with the flare-up predictive type,the values of I-FOBT were generally low during the study period with stable symptoms.Two to four weeks before the flare-up of symptoms,the I-FOBT values were high.Thus,in these patients,I-FOBT could predict the flare-up before symptoms emerged.CONCLUSION:Flare-up could be predicted by I-FOBT in approximately 20% of UC patients.These results warrant periodical I-FOBT in UC patients.

EVALUATION OF REVERSE PASSIVE HEMAGGLUTINATION （RPHA） FECAL OCCULT BLOOD TEST IN SCREENING OF COLORECTAL NEOPLASIA

A high risk population consisting of 3034 people with history of rectal polyps or ulcers were screened for colorectal neoplasia with Reverse Passive Hemagglutination Fecal Occult Blood Test (RPHA FOB) and 60 cm fiberoptic colonoscopy. Among 2553 subjects (84.1%)who completed both tests, 11 cases of colorectal malignancies and 465 cases of polyps were detected.Using colonoscopic finding and histopathological examination as the 'gold standard' of diagnosis, results showed that FOB positivity of polyps was related to their size, macroscopic appearance and surface features but no correlation between bleeding of polyps and their location, numbers, pathological types were found. In this study the sensitivity of RPHA in screening of colorectal malignancy was 63.6% (7/11), while that for polyps was only 21.1% (98/465) . For screening of colorectal neoplasia (cancer+polyps) the overall sensitivity and specificity of RPHA FOB were 22.1% and 82.4%, the positive and negative predictive values were 22.3% and 82.2% respectively. Amoug 465 polyps there were 195 adenomas, further analysis showed that villous and tubulovillous adenomas had higher intestinal bleeding rate (FOB positive)than tubular type (45.5%,30.0% and 17.8% respectively, X2=5.8, p=0.05). The results indicate that although the sensitivity of RPHA FOB in screening for colorectal polyps was generally low, but about 40% (8/21) of villous and tubulovillous adenoma which present higher tendency of malignant transformation can be detected by RPHA FOB as a screening Procedure. So the authors suggest that screening of colorectal neoplasia be not only a procedure of secondary prevention but also a measure of primary prevention for colorectal cancer.Accepted March 22, 1994

Evaluation of fecal occult blood test with reverse passive hemagglutination for colorectal neoplasm screen *

AIM To evaluate the one sampling and three sampling reverse passive hemagglutination fecal occult blood test (RPHA FOBT) for colorectal neoplasm screening.

CT colonography after incomplete colonoscopy in subjects with positive faecal occult blood test

AIM： To report our experience with computed tomography colonography （CTC） systematically performed in subjects with positive faecal occult blood test （FOBT） and an incomplete colonoscopy in the setting of a population-based screening for colorectal cancer （CRC）. METHODS： From April 2006 to April 2007, 43 290 individuals （age range 50-70） who adhered to the regional screening program for the prevention of CRC underwent immunochemical FOBT. FOBT was positive in 1882 subjects （4.3%）. 1463 （77.7%） of these subjects underwent colonoscopy, 903 performed in a single center. Of 903 colonoscopies 65 （7.2%） were incomplete. Forty-two of these subjects underwent CTC. CTC was performed with a 16-MDCT scanner after standard bowel prep （polyethyleneglycole） in both supine and prone position. Subjects whose CTC showed polyps or masses were referred to the endoscopist for repeat colonoscopy under sedation or underwent surgery. Perlesion and per-segment positive predictive values （PPV） were calculated. RESULTS： Twenty-one （50%） of 42 CTCs showed polyps or masses. Fifty-five of these subjects underwent a repeat colonoscopy, whereas 2 subjects underwent surgery for colonic masses of indeterminate nature. Four subjects refused further examinations. CTC correctly identified 2 colonic masses and 20 polyps. PPV for masses or polyps greater than 9 mm was of 87.5%. Per-lesion and per-segment PPV were, respectively, 83.3% and 83.3% for polyps greater or equal to 10 mm, and 77.8% and 85.7% for polyps of 6-9 mm. CONCLUSION： In the context of a screening program for CRC based on FOBT, CTC shows high per-segment and per-lesion PPV for colonic masses and polyps greater than 9 mm. Therefore, CTC has the potential to become a useful technique for evaluation of the non visualized part of the colon after incomplete colonoscopy.

Colorectal cancer screening: Comparison of transferrin and immuno fecal occult blood test

AIM: To evaluate the sensitivity and specificity of transfesrrin dipstick test (Tf) in colorectal cancer (CRC) screening and precancerous lesions screening. METHODS: Eight hundreds and sixty-one individuals at high-risk for CRC were recruited. Six hundreds and eleven subsequently received the three fecal occult blood tests and colonoscopy with biopsy performed as needed. Fecal samples were obtained on the day before colonoscopy. Tf, immuno fecal occult blood test (IFOBT) and guaiac fecal occult blood test (g-FOBT) were performed simultaneously on the same stool. To minimize false-negative cases, all subjects with negative samples were asked to provide an additional stool specimen for a second test even a third test. If the results were all negative after testing three repeated samples, the subject was considered a true negative. The performance characteristics of Tf for detecting CRC and precancerous lesions were examined and compared to those of IFOBT and the combination of Tf, IFOBT and g-FOBT. RESULTS: A total of six hundreds and eleven subjects met the study criteria including 25 with CRC and 60 with precancerous lesions. Sensitivity for detecting CRC was 92% for Tf and 96% for IFOBT, specificities of Tf and IFOBT were both 72.0% (95% CI: 68.2%-75.5%; χ2 = 0.4, P > 0.05); positive likelihood ratios of those were 3.3 (95% CI: 2.8-3.9) and 3.4 (95% CI: 2.9-4.0), respectively. In precancerous lesions, sensitivities for Tf and IFOBT were 50% and 58%, respectively (χ 2 = 0.8, P > 0.05); specificities of Tf and IFOBT were 71.5% (95% CI: 67.6%-75.1%) and 72.2% (95% CI: 68.4%-75.8%); positive likelihood ratios of those were 1.8 (95% CI: 1.3-2.3) and 2.1 (95% CI: 1.6-2.7), respectively; compared to IFOBT, g-FOBT+ Tf+ IFOBT had a significantly higher positive rate for precancerous lesions (83% vs 58%, respectively; χ 2 = 9.1, P < 0.05). In patients with CRC and precancerous lesions, the sensitivities of Tf and IFOBT were 62% and 69% (χ 2 = 0.9, P > 0.05); specificities of those were 74.5% (95% CI: 70.6%-78.1%) and 75.5% (95% CI: 71.6%-79.0%); positive likelihood ratios of those were 2.5 (95% CI: 2.0-3.1) and 2.8 (95% CI: 2.3-3.5). Compared to IF-OBT alone, combining g-FOBT, IFOBT and Tf led to significantly increased sensitivity for detecting CRC and cancerous lesions (69% vs 88%, respectively; χ 2 = 9.0, P < 0.05). CONCLUSION: Tf dipstick test might be used as an ad- ditional tool for CRC and precancerous lesions screening in a high-risk cohort.

基于FIB、HB、FOBT、CEA构建的Logistic回归模型对结直肠癌的诊断价值

目的 评价纤维蛋白原(FIB)、血红蛋白(HB)、癌胚抗原(CEA)和粪便隐血试验(FOBT)联合检测在结直肠癌患者中的诊断价值,为结直肠癌诊断提供参考。方法 选取宁夏医科大学总医院2021年1月至2022年6月结直肠外科收治的110例结直肠癌患者作为癌症组,选取同期病房收治的43例良性结直肠疾病患者为非癌症组。回顾性分析并比较癌症组及非癌症组常规实验室指标(血常规、生化常规、肿瘤标志物、细胞因子、FOBT)结果,采用Logistic回归分析结直肠癌的影响因素并构建Logistic回归模型,采用受试者工作特征(ROC)曲线分析Logistic回归模型对结直肠癌的诊断价值;进一步构建诊断结直肠癌的列线图并绘制校准曲线图进行内部验证。结果 癌症组患者血FIB、CEA水平及FOBT阳性率高于非癌症组,A/G、HB水平低于非癌症组,差异均有统计学意义(P<0.05)。将FIB、HB、FOBT、CEA进行多因素Logistic回归分析,建立Logistic回归模型作为4项指标联合检测模型:P=1/[1+e^(-(13.792-0.144×X_(1)+1.057×X_(2)+0.560×X_(3)+3.029×X_(4)))],其中X_(1)为HB水平,X_(2)为FIB水平,X_(3)为CEA水平,X_(4)为FOBT检测结果(阳性=1,阴性=0)。ROC曲线分析结果显示,当最大约登指数为0.841时,Logistic回归模型诊断结直肠癌的灵敏度为86.4%,特异度为97.7%,曲线下面积(AUC)为0.961(95%CI:0.933~0.988)。建立Logistic回归模型的列线图,并绘制校准曲线图,结果提示该模型的预测概率与实际概率具有较好的一致性。结论 基于FIB、HB、CEA和FOBT 4项指标构建的Logistic回归模型,对结直肠癌有着较好的诊断价值,也为临床对结直肠癌的早期筛查和诊断提供了一定的方向。

To scope or not-the challenges of managing patients with positive fecal occult blood test after recent colonoscopy

BACKGROUND Colorectal cancer(CRC) is a major health problem. There is minimal consensus of the appropriate approach to manage patients with positive immunochemical fecal occult blood test(iFOBT), following a recent colonoscopy.AIM To determine the prevalence of advanced neoplasia in patients with a positive iFOBT after a recent colonoscopy, and clinical and endoscopic predictors for advanced neoplasia.METHODS The study recruited i FOBT positive patients who underwent colonoscopy between July 2015 to March 2020. Data collected included demographics, clinical characteristics, previous and current colonoscopy findings. Primary outcome was the prevalence of CRC and advanced neoplasia in a patient with positive iFOBT and previous colonoscopy. Secondary outcomes included identifying any clinical and endoscopic predictors for advanced neoplasia.RESULTS The study included 1051 patients(male 53.6%;median age 63). Forty-two(4.0%) patients were diagnosed with CRC, 513(48.8%) with adenoma/sessile serrated lesion(A-SSL) and 257(24.5%) with advanced A-SSL(AA-SSL). A previous colonoscopy had been performed in 319(30.3%). In this cohort, four(1.3%) were diagnosed with CRC, 146(45.8%) with A-SSL and 56(17.6%) with AA-SSL. Among those who had a colonoscopy within 4 years, none had CRC and 7 had AA-SSL. Of the 732 patients with no prior colonoscopy, there were 38 CRCs(5.2%). Independent predictors for advanced neoplasia were male [odds ratio(OR) = 1.80;95% confidence interval(CI): 1.35-2.40;P < 0.001), age(OR = 1.04;95%CI: 1.02-1.06;P < 0.001) and no previous colonoscopy(OR = 2.07;95%CI: 1.49-2.87;P < 0.001).CONCLUSION A previous colonoscopy, irrespective of its result, was associated with low prevalence of advanced neoplasia, and if performed within four years of a positive iFOBT result, was protective against CRC.

结直肠癌患者血浆Septin9 DNA甲基化联合FOBT检测的临床应用价值

目的:探讨血浆Septin9 DNA甲基化及粪便隐血试验(FOBT)在结直肠癌(CRC)诊断中的应用价值。方法:回顾性收集2017年6月至2022年1月我院收治并经病理检查确诊的101例结直肠良性腺瘤患者、209例结直肠癌患者分别作为良性腺瘤组和结直肠癌组,选取同期在我院进行体检的98例健康人群作为正常对照组,比较三组一般资料及血浆Septin9 DNA甲基化及FOBT阳性情况,比较不同病理特征、不同临床分期结直肠癌患者血浆Septin9 DNA甲基化、FOBT阳性情况,采用受试者工作曲线(ROC)评估血浆Septin9 DNA甲基化、FOBT单项及联合检测对结直肠癌的诊断价值。结果:三组血浆Septin9 DNA甲基化、FOBT阳性率比较,结直肠癌组高于良性腺瘤组及正常对照组,良性腺瘤组高于正常对照组(P<0.05);肿瘤低分化、淋巴结转移、脉管/神经侵犯的结直肠癌患者血浆Septin9 DNA甲基化和FOBT阳性率高于肿瘤高分化、中分化及未发生淋巴结转移、未发生脉管/神经侵犯的结直肠癌患者(P<0.05);随着结直肠癌TNM临床分期升高,血浆Septin9 DNA甲基化及FOBT阳性率升高,差异具有统计学意义(P<0.05);血浆Septin9 DNA甲基化和FOBT联合诊断结直肠癌的敏感度、曲线下面积(AUC)(87.08%、0.885)均高于两者单独诊断(59.33%、0.744和52.63%、0.643,P<0.05);血浆Septin9 DNA甲基化诊断结直肠癌的特异度、阳性预测值和阴性预测值分别为89.45%、85.52%和67.68%;FOBT分别为76.38%、70.06%和60.56%,两者联合诊断分别为89.95%、90.10%和86.89%。联合诊断优于单项诊断。结论:随着结直肠病变恶性程度的增加,血浆Septin9 DNA甲基化和FOBT阳性率升高,血浆Septin9 DNA甲基化、FOBT联合检测对结直肠癌具有较高的诊断价值,可作为结直肠癌的实验室诊断指标。

Sample preference for colorectal cancer screening tests: Blood or stool?

Objective: Despite the high prevalence of CRC and the proven benefits of faecal sampling tests, participation rates in CRC screening are suboptimal. Literature has identified a number of barriers to participation, including faecal aversion. Emerging test technologies suggest blood-based molecular markers might provide an alternative, more acceptable option, for CRC screening tests. We aim to determine preference for blood compared to faeces as the sample for the screening test. Methods: A survey was mailed to 956 South Australians aged 50 to 74 years. Data were collected on sample preference, demographic variables, and ratings of screening test convenience and comfort. Results: The survey yielded a 43% response rate. The majority of participants preferred to provide a blood sample (78% v 22%, p < 0.001). Women were more likely to prefer blood than men (82% vs 74%, p = 0.05). Sample experience influenced preferences, with a significantly higher preference for faeces among participants with experience in faecal sampling (27% vs 17% with no experience, p < 0.05). Participants who preferred to provide a faecal sample rated it significantly more convenient (p < 0.001), more comfortable (p < 0.001), and more acceptable (p < 0.001) than those who preferred blood sampling. Conclusions: Survey participants overwhelmingly indicate a preference for the idea of a blood sample over a faecal sample for CRC screening. Preference was influenced by gender, experience with sampling method and the individual’s perception of sampling convenience, sampling comfort and sample acceptability. Our results suggest population participation rates are likely to improve with blood-based screening tests.

Occult hepatitis B virus infection and blood transfusion

Transfusion-transmitted infections including hepatitis B virus(HBV) have been a major concern in transfusion medicine. Implementation of HBV nucleic acid testing(NAT) has revealed occult HBV infection(OBI) in blood donors. In the mid-1980 s, hepatitis B core antibody(HBc) testing was introduced to screen blood donors in HBV non-endemic countries to prevent transmission of non-A and non-B hepatitis. That test remains in use for preventing of potential transmission of HBV from hepatitis B surface antigen(HBs Ag)-negative blood donors, even though anti-hepatitis C virus testshave been introduced. Studies of anti-HBc-positive donors have revealed an HBV DNA positivity rate of 0%-15%. As of 2012, 30 countries have implemented HBV NAT. The prevalence of OBI in blood donors was estimated to be 8.55 per 1 million donations, according to a 2008 international survey. OBI is transmissible by blood transfusion. The clinical outcome of occult HBV transmission primarily depends on recipient immune status and the number of HBV DNA copies present in the blood products. The presence of donor anti-HBs reduces the risk of HBV infection by approximately five-fold. The risk of HBV transmission may be lower in endemic areas than in non-endemic areas, because most recipients have already been exposed to HBV. Blood safety for HBV, including OBI, has substantially improved, but the possibility for OBI transmission remains.

具核梭杆菌在结直肠癌筛查中的应用价值

目的探讨具核梭杆菌(Fn)在结直肠癌筛查中的临床价值。方法前瞻性纳入于2022年7月至2023年12月期间在首都医科大学附属北京友谊医院行结肠镜检查者。于结肠镜检查前3 d内留取粪便样本,采用定量聚合酶链反应(qPCR)法检测粪便中菌群Fn的相对丰度,同时行粪便隐血试验(FOBT)。采用受试者操作特征(ROC)曲线评估Fn对结直肠癌的诊断效能。结果共纳入271例受试者,其中诊断结直肠癌58例(21.40%)。结直肠癌组患者粪便中的Fn相对丰度显著高于非结直肠癌组[6.602(3.716,8.997)vs.1.665(0.593,4.752)],差异有统计学意义(P<0.05)。Fn诊断结直肠癌的曲线下面积(AUC)为0.750(95%CI:0.680~0.820,P<0.05),对应敏感度、特异度和阴性预测值分别为0.724、0.742和0.908。在FOBT结果阴性者中,Fn诊断结直肠癌的敏感度、特异度和阴性预测值分别为0.714、0.730和0.983。Fn联合FOBT诊断结直肠癌的AUC为0.894(95%CI:0.848~0.940,P<0.05),对应敏感度、特异度和阴性预测值分别为0.897、0.765和0.964,诊断效能显著优于单独检测Fn(P<0.05)。结论粪便Fn在结直肠癌筛查中具有较高的敏感性、特异性和阴性预测值,与FOBT联合应用可进一步提升结直肠癌检出率。因此,粪便Fn是结直肠癌筛查有价值的无创生物标志物,可有效避免FOBT阴性者中结直肠癌的漏诊。粪便Fn丰度升高者应尽快行结肠镜检查,若Fn与FOBT均阴性,则可基本排除结直肠癌。

自动粪便分析仪与人工复核法检测粪便结果的比较分析

目的比较自动粪便分析仪与人工复核法两种粪便检测方法的检验效果。方法收集2022年9月—2023年8月三明市第二医院就诊患者的9402份新鲜粪便标本,分别使用FA160自动粪便分析仪和人工复核法检测粪便有形成分(白细胞、红细胞、脂肪球、真菌)和隐血,记录两种方法的检测结果并进行统计学分析。结果自动粪便分析仪检测白细胞、红细胞、脂肪球、真菌和隐血的阳性检出率分别为4.90%、2.67%、6.31%、4.54%、25.34%,人工复核法阳性检出率分别为4.17%、2.22%、5.55%、5.29%、25.23%,自动粪便分析仪对粪便有形成分的阳性检出率除真菌略低于人工复核外,其他各项指标均高于人工复核,且差异均有统计学意义(均P<0.05),而粪便隐血试验的阳性检出率比较差异无统计学意义(P>0.05)。以人工复核法为标准,自动粪便分析仪检测白细胞、红细胞、脂肪球、真菌、隐血的阳性符合率分别为91.07%、96.17%、94.83%、78.07%、98.19%;阴性符合率分别为98.85%、99.46%、98.90%、99.56%、99.25%;阳性预测值分别为77.44%、80.08%、83.47%、90.87%、97.77%;阴性预测值分别为99.61%、99.91%、99.69%、98.79%、99.39%。结论自动粪便分析仪与人工复核法的检测结果虽然符合率较高,但还存在漏检和误检。因此对自动分析结果必须进行人工复核,提高检测结果的准确性,为临床提供可靠的参考依据。

泌尿系统疾病诊断中应用尿液沉渣隐血检验及尿液分析仪的价值

目的探讨尿液沉渣隐血检验及尿液分析仪在泌尿系统疾病诊断中的应用价值,以期为临床早期明确诊断、制订治疗方案提供参考依据。方法选取我院2020年6月至2022年6月就诊的260例泌尿系统疾病患者作为研究对象,入院后均行尿液沉渣隐血检验及尿液分析仪检测,以干化学试带法检验结果为“金标准”,比较尿液沉渣隐血检验、尿液分析仪检测单独、联合检查对红细胞、白细胞阳性诊断结果、诊断效能,并比较其对于不同类型泌尿系统疾病的检出率。结果与尿液沉渣隐血检验、尿液分析仪单独诊断比较,联合诊断对于红细胞阳性诊断灵敏度96.20%、准确度95.38%较高,漏诊率3.80%较低(P<0.05);与尿液沉渣隐血检验、尿液分析仪单独诊断比较,联合诊断对于白细胞阳性诊断灵敏度95.06%、准确度95.38%较高,漏诊率4.94%较低(P<0.05);且联合诊断对肾小球病、肾结石、急性肾炎综合征、肾肿瘤检出率高于尿液沉渣隐血检验、尿液分析仪单独诊断(P<0.05)。结论尿液沉渣隐血检验、尿液分析仪联合应用可有效提高泌尿系统疾病诊断效能,为临床早期诊断、鉴别疾病类型提供参考,以针对性制订治疗方案,改善预后。

联合检测肿瘤M2-PK与CEA和FOBT对结直肠癌早期发现的意义

目的探讨联合检测肿瘤M2型丙酮酸激酶(tumor M2-PK)与癌胚抗原(carcino-embryonic antigen,CEA)和粪便潜血试验(faecal occult blood testing,FOBT)对结直肠癌早期诊断的意义。方法以44例结直肠癌患者和22名健康人群为研究对象,用酶联免疫吸附剂测定(enzyme-linked immunosorbent assay,ELISA)血清和粪便中的tumor M2-PK表达。另外检测受试者血CEA水平及粪便潜血试验。结果①血清和粪便tumor M2-PK在结直肠癌的诊断中敏感性分别为59.1%、63.6%,特异性分别为86.4%、81.8%。②血清tumor M2-PK和粪便tumor M2-PK的吻合系数k为0.522,吻合度有统计学意义。③结直肠癌患者血清和粪便中tumor M2-P的水平与肿瘤的T分期均具有相关性。结论血清tumor M2-PK+CEA+FOBT和粪便tumor M2-PK+CEA+FOBT联合检测均可提高结直肠癌诊断的敏感性;血清tumor M2-PK+CEA+FOBT更适合对健康人群的普查,粪便tumor M2-PK+CEA+FOBT更适合在结直肠癌高危人群和临床有症状人群的筛查中应用。

低剂量CT仿真结肠镜结合FOBT检查对结直肠癌的诊断价值

目的探讨低剂量CT仿真结肠镜结合增强扫描(CTVC)及大便潜血检测(fecal occult blood test,FOBT)诊断结直肠癌临床价值。方法选取我院160例结肠占位性病变患者作为观察对象,均行CTVC及FOBT,分析低剂量CTVC、FOBT的临床效果。结果病理学结果显示,160例结直肠占位性病变中,93例为结直肠癌、67例为良性病变。结肠镜阳性检出78例、阴性检出54例,常规CT检出91例、阴性检出58例,低剂量CTVC阳性检出91例、阴性检出58例,结肠镜、常规CT、CTVC与病理学结果的Kappa值分别为0.682、0.857、0.857;此外,低剂量CTVC组同常规剂量组比较,其放射剂量长度乘积(DLP)、有效放射剂量(ED)均显著下降。FOBT阳性检出84例、阴性检出66例,与病理学结果的Kappa值为0.874。低剂量、FOBT的曲线下面积(ACU)、特异度分别为0.922、0.944、0.978、0.683,2者联合的ACU、特异度为0.987、0.989。结论FOBI辅助低剂量CTVC能够提高对结肠癌的诊断效果,且降低患者的辐射剂量,值得临床推广应用。

粪便隐血试验在体检人群中对大肠癌早期筛查的价值

目的研究免疫化学法粪便隐血试验(FIT)在体检人群中大肠癌早期筛查的应用价值。方法选取2017年9月至2020年9月该院体检中心健康体检人群,收集行FIT患者的基本资料,根据内镜下有无新生物、FIT检测值、新生物直径及位置进行分组;采用单样本K-S检验、Kruskal-Wallis H检查、χ^(2)检验进行组间统计分析,Spearman法分析双变量关系,多重线性回归模型分析性别、年龄及新生物病理类型、位置、直径、个数对FIT的预测价值。结果315例患者满足FIT>100 ng/mL并完成肠镜检查,包括大肠癌(腺癌)19例,腺瘤性息肉94例,增生性息肉59例,正常及其他疾病143例,男性大肠癌发病比率高于女性(χ^(2)=15.74,P<0.01)。FIT检测值平均中位水平:肿瘤组>腺瘤性息肉组>无新生物组>增生性息肉组,除无新生物组与增生性息肉组之间差异无统计学意义(P=0.206),其余各组间差异均有统计学意义(P<0.05)。随着FIT检测值的增加,肠镜正常和增生性息肉的占比下降,腺瘤和腺癌的占比升高(P<0.01)。新生物直径中位水平:肿瘤组>腺瘤性息肉组>增生性息肉组(P<0.01)。随着新生物直径的增加,增生性息肉百分比下降,肿瘤所占比例增加(P<0.01)。左半结肠发病率显著高于结肠其他部位(P<0.01)。双变量相关分析显示,FIT检测值与新生物病理类型、直径、个数呈正相关(r=0.291、0.591、0.354,P<0.01)。多重线性回归分析显示新生物病理类型、直径、个数是影响FIT检测值的独立影响因素,线性方程式为Y=-584.875+319.315×1+264.241×2+109.942×3(×1、×2、×3分别代表新生物病理类型、直径、个数),P<0.01。结论FIT能够有效应用于大肠癌的早期筛查,其检测值高低与肠道新生物癌变程度、直径呈正相关,男性患者、左半结肠病变、大直径新生物易发生癌变。

Early diagnostic strategies for colorectal cancer

At present,cancer is still an important factor threatening human health.Colorectal cancer(CRC)is one of the top three most common cancers worldwide and one of the deadliest malignancies in humans.The latest data showed that CRC incidence and mortality rank third and second,respectively,among global malignancies.Early and accurate diagnosis is crucial to reduce the morbidity,mortality and improve survival of patients with CRC,but the current early diagnostic methods have limitations.The effectiveness and compliance of diagnostic methods have a certain impact on whether people choose screening.In this editorial,we explore strategies for the early diagnosis of CRC,including stool-based,blood-based,direct visualization,and imaging examinations.