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@ARTICLE{Selby:144684,
      author       = {K. Selby and E. H. Levine and C. Doan and A. Gies$^*$ and
                      H. Brenner$^*$ and C. Quesenberry and J. K. Lee and D. A.
                      Corley},
      title        = {{E}ffect of {S}ex, {A}ge and {P}ositivity {T}hreshold on
                      {F}ecal {I}mmunochemical {T}est {A}ccuracy: a {S}ystematic
                      {R}eview and {M}eta-{A}nalysis.},
      journal      = {Gastroenterology},
      volume       = {157},
      number       = {6},
      issn         = {0016-5085},
      address      = {Philadelphia, Pa. [u.a.]},
      publisher    = {Saunders},
      reportid     = {DKFZ-2019-02126},
      pages        = {1494-1505},
      year         = {2019},
      note         = {157(6):1494-1505},
      abstract     = {Quantitative fecal immunochemical tests (FITs) for
                      hemoglobin are commonly used for colorectal cancer (CRC)
                      screening. We aimed to quantify the change in CRC and
                      advanced adenoma detection and number of positive test
                      results at different positivity thresholds and by sex and
                      age.We searched MEDLINE and EMBASE, selecting articles of
                      FIT for CRC detection in asymptomatic adults undergoing
                      screening. We calculated sensitivity and specificity, as
                      well as detected number of cancers, advanced adenomas, and
                      positive test results at positivity thresholds ≤10 μg
                      hemoglobin/g feces, 10 to ≤20 μg/g, 20 to ≤30 μg/g,
                      and >30 μg/g. We also analyzed results from stratified by
                      patient sex, age, and reference standard.Our meta-analysis
                      comprised 46 studies with 2.4 million participants and 6478
                      detected cancers. Sensitivity for detection of CRC increased
                      from $69\%$ $(95\%$ CI, $63\%-75\%)$ at thresholds >10 μg/g
                      and ≤20 μg/g to $80\%$ $(95\%$ CI, $76\%-83\%)$ at
                      thresholds ≤10 μg/g. At these threshold values,
                      sensitivity for detection of advanced adenomas increased
                      from $21\%$ $(95\%$ CI, $18\%-2\%5)$ to $31\%$ $(95\%$ CI,
                      $27\%-35\%),$ whereas specificity decreased from $94\%$
                      $(95\%$ CI, $93\%-96\%)$ to $91\%$ $(95\%$ CI, $89\%-93\%).$
                      In 3 studies stratified by sex, sensitivity of CRC detection
                      was $77\%$ in men $(95\%$ CI, $75\%-79\%)$ and $81\%$ in
                      women $(95\%$ CI, $60\%-100\%)$ (P=.68). In 3 studies
                      stratified by age groups, sensitivity of CRC detection was
                      $85\%$ for ages 50-59 years $(95\%$ CI, $71\%-99\%)$ and
                      $73\%$ for ages 60-69 years $(95\%$ CI, $71\%-75\%)$
                      (P=.10). All studies with colonoscopy follow up had similar
                      sensitivity levels for detection of CRC to studies that
                      analyzed 2-year registry follow-up data $(74\%;$ $95\%$ CI,
                      $68\%-78\%$ vs $75\%;$ $95\%$ CI, $73\%-77\%).In$ a
                      meta-analysis of studies that analyzed detection of CRC and
                      advanced adenomas at different FIT positivity thresholds, we
                      found the sensitivity and specificity of detection to vary
                      with positive cut-off value. It might be possible to
                      decrease positive threshold values for centers with
                      sufficient follow-up colonoscopy resources. More research is
                      needed to precisely establish FIT thresholds for each sex
                      and age subgroup.},
      subtyp        = {Review Article},
      cin          = {C070 / C120 / L101},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331 / I:(DE-He78)C120-20160331 /
                      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:31472152},
      doi          = {10.1053/j.gastro.2019.08.023},
      url          = {https://inrepo02.dkfz.de/record/144684},
}