Fecal DNA vs. Fecal Occult Blood for Colorectal-Cancer Screening
Fecal DNA vs. Fecal Occult Blood for Colorectal-Cancer Screening
Imperiale TF, Ransohoff DF, Itzkowitz SH, et al.
N Engl J Med. 2004,351:2704-2714.
To evaluate whether DNA analysis of stool samples has greater sensitivity than the Hemoccult II fecal occult blood test in detecting colorectal cancer, we compared the 2 methods in average-risk, asymptomatic persons aged 50 years and older.
A total of 4404 persons completed all aspects of the study: they submitted one stool specimen for DNA analysis, underwent standard Hemoccult II testing, and underwent co lo noscopy. Data from a subgroup of 2507 persons were analyzed. This subgroup included all those with a diagnosis of invasive adenocarcinoma or advanced adenoma as well as randomly selected persons who did not have polyps or who had minor polyps. The fecal DNA panel consisted of 21 mutations.
Of 31 invasive cancers, the fecal DNA panel detected 16 and the Hemoccult II test identified 4 (51.6% vs 12.9%; P = .003). For invasive cancers plus adenomas with high-grade dysplasia, the DNA panel detected 29 and the Hemoccult II test identified 10 of a total of 71 (40.8% vs 14.1%; P < .001). In evaluating a subgroup of 418 persons with advanced neoplasia, the DNA panel results were positive in 76 (18.2%) and the Hemoccult II test results were positive in 45 (10.8%). The rates of specificity in persons with negative findings on colonoscopy were the same for the 2 diagnostic methods: 94.4% for the fecal DNA panel and 95.2% for the Hemoccult II test.
Although both noninvasive diagnostic tests failed to identify most of the neoplastic lesions identified by colonoscopy, a higher proportion of significant colorectal neoplasias were detected by the multitarget analysis of fecal DNA than by the Hemoccult II fecal occult blood test.
Imperiale TF, Ransohoff DF, Itzkowitz SH, et al.
N Engl J Med. 2004,351:2704-2714.
To evaluate whether DNA analysis of stool samples has greater sensitivity than the Hemoccult II fecal occult blood test in detecting colorectal cancer, we compared the 2 methods in average-risk, asymptomatic persons aged 50 years and older.
A total of 4404 persons completed all aspects of the study: they submitted one stool specimen for DNA analysis, underwent standard Hemoccult II testing, and underwent co lo noscopy. Data from a subgroup of 2507 persons were analyzed. This subgroup included all those with a diagnosis of invasive adenocarcinoma or advanced adenoma as well as randomly selected persons who did not have polyps or who had minor polyps. The fecal DNA panel consisted of 21 mutations.
Of 31 invasive cancers, the fecal DNA panel detected 16 and the Hemoccult II test identified 4 (51.6% vs 12.9%; P = .003). For invasive cancers plus adenomas with high-grade dysplasia, the DNA panel detected 29 and the Hemoccult II test identified 10 of a total of 71 (40.8% vs 14.1%; P < .001). In evaluating a subgroup of 418 persons with advanced neoplasia, the DNA panel results were positive in 76 (18.2%) and the Hemoccult II test results were positive in 45 (10.8%). The rates of specificity in persons with negative findings on colonoscopy were the same for the 2 diagnostic methods: 94.4% for the fecal DNA panel and 95.2% for the Hemoccult II test.
Although both noninvasive diagnostic tests failed to identify most of the neoplastic lesions identified by colonoscopy, a higher proportion of significant colorectal neoplasias were detected by the multitarget analysis of fecal DNA than by the Hemoccult II fecal occult blood test.