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@ARTICLE{Gies:135955,
author = {A. Gies$^*$ and M. Bhardwaj$^*$ and C. Stock$^*$ and P.
Schrotz-King$^*$ and H. Brenner$^*$},
title = {{Q}uantitative fecal immunochemical tests for colorectal
cancer screening.},
journal = {International journal of cancer},
volume = {143},
number = {2},
issn = {0020-7136},
address = {Bognor Regis},
publisher = {Wiley-Liss},
reportid = {DKFZ-2018-00692},
pages = {234 - 244},
year = {2018},
abstract = {Fecal immunochemical tests (FITs) for hemoglobin (Hb) are
increasingly used for colorectal cancer (CRC) screening. We
aimed to review, summarize and compare reported diagnostic
performance of various FITs. PubMed and Web of Science were
searched from inception to July 24, 2017. Data on diagnostic
performance of quantitative FITs, conducted in
colonoscopy-controlled average-risk screening populations,
were extracted. Summary receiver operating characteristic
(ROC) curves were plotted and correlations between
thresholds, positivity rates (PRs), sensitivities and
specificities were assessed. Seven test brands were
investigated across 22 studies. Although reported
sensitivities for CRC, advanced adenoma (AA) and any
advanced neoplasm (AN) varied widely (ranges: $25-100\%,$
$6-44\%$ and $9-60\%,$ respectively), with specificities for
AN ranging from $82\%$ to $99\%,$ the estimates were very
close to the respective summary ROC curves whose areas under
the curve $(95\%$ CI) were 0.905 (0.88-0.94), 0.683
(0.67-0.70) and 0.710 (0.70-0.72) for CRC, AA and AN,
respectively. The seemingly large heterogeneity essentially
reflected variations in test thresholds (range: 2-82 µg
Hb/g feces) and showed moderate correlations with
sensitivity (r = -0.49) and specificity (r = 0.60)
for AN. By contrast, observed PRs (range: $1-21\%)$ almost
perfectly correlated with sensitivity (r = 0.84) and
specificity (r = -0.94) for AN. The apparent large
heterogeneity in diagnostic performance between various FITs
can be almost completely overcome by appropriate threshold
adjustments. Instead of simply applying the threshold
recommended by the manufacturer, screening programs should
adjust the threshold to yield a desired PR which is a very
good proxy indicator for the specificity and the subsequent
colonoscopy workload.},
subtyp = {Review Article},
cin = {C070 / G110 / L101},
ddc = {610},
cid = {I:(DE-He78)C070-20160331 / I:(DE-He78)G110-20160331 /
I:(DE-He78)L101-20160331},
pnm = {313 - Cancer risk factors and prevention (POF3-313)},
pid = {G:(DE-HGF)POF3-313},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:29277897},
doi = {10.1002/ijc.31233},
url = {https://inrepo02.dkfz.de/record/135955},
}