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@ARTICLE{Chandrapalan:177909,
      author       = {S. Chandrapalan and S. Bosch and J. Cubiella and J.
                      Guardiola and P. Kimani and C. Mulder and K. Persaud and T.
                      G. J. de Meij and D. F. Altomare and H. Brenner$^*$ and N.
                      K. H. de Boer and L. Ricciardiello and R. P. Arasaradnam},
      title        = {{S}ystematic review with meta-analysis: volatile organic
                      compound analysis to improve faecal immunochemical testing
                      in the detection of colorectal cancer.},
      journal      = {Alimentary pharmacology $\&$ therapeutics},
      volume       = {54},
      number       = {1},
      issn         = {0269-2813},
      address      = {Oxford},
      publisher    = {Wiley-Blackwell},
      reportid     = {DKFZ-2021-02931},
      pages        = {14-23},
      year         = {2021},
      abstract     = {Faecal immunochemical test (FIT) is emerging as a valid
                      test to rule-out the presence of colorectal cancer (CRC).
                      However, the accuracy of FIT is dependent on the cut-off
                      applied. An additional low-cost test could improve further
                      detection of CRC.To evaluate the efficacy of combined FIT
                      and volatile organic compounds (VOC) in the detection of CRC
                      within symptomatic populations.Systematic reviews on the
                      diagnostic accuracy of FIT and VOC, for the detection of
                      CRC, were updated. Meta-analyses were performed adopting a
                      bivariate model for sensitivity and specificity. Clinical
                      utility of combined FIT and VOC was estimated using Fagan's
                      nomogram. Post-test probability of FIT negatives was used as
                      a pre-test probability for VOC.The pooled sensitivity and
                      specificity of FIT at 10 µg/g faeces, for the detection of
                      CRC, were 0.914 $(95\%$ confidence interval
                      [CI] = 0.894-0.936) and 0.783 (CI = 0.850-0.696),
                      respectively. For VOC, the sensitivity was 0.837
                      (CI = 0.781-0.881) and the specificity was 0.803
                      (CI = 0.870-0.712). The area under the curve for FIT and
                      VOC were 0.926 and 0.885, respectively. In a population with
                      $5\%$ CRC prevalence, the estimated probability of having
                      CRC following a negative FIT was $0.5\%$ and following both
                      negative FIT and VOC was $0.1\%.In$ a FIT-negative
                      symptomatic population, VOC can be a good test to rule-out
                      the presence of CRC. The estimated probability reduction by
                      $0.4\%$ when both tests being negative offers adequate
                      safety netting in primary care for the exclusion of CRC. The
                      number needed to colonoscope to identify one CRC is eight if
                      either FIT or VOC positive. Cost-effectiveness and clinical
                      accuracy of this approach will need further evaluation.},
      subtyp        = {Review Article},
      keywords     = {Colorectal Neoplasms: diagnosis / Colorectal Neoplasms:
                      epidemiology / Early Detection of Cancer / Feces / Humans /
                      Occult Blood / Sensitivity and Specificity / Volatile
                      Organic Compounds / Volatile Organic Compounds (NLM
                      Chemicals)},
      cin          = {C070},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:34004036},
      doi          = {10.1111/apt.16405},
      url          = {https://inrepo02.dkfz.de/record/177909},
}