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Open AccessArticle

Fecal Immunochemical Tests for Colorectal Cancer Screening: Is Fecal Sampling from Multiple Sites Necessary?

1
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
2
Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
3
Heidelberg Medical Faculty, Heidelberg University, 69120 Heidelberg, Germany
4
German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), 69120 Heidelberg, Germany
*
Author to whom correspondence should be addressed.
Cancers 2019, 11(3), 400; https://doi.org/10.3390/cancers11030400
Received: 7 February 2019 / Revised: 13 March 2019 / Accepted: 19 March 2019 / Published: 21 March 2019
Fecal immunochemical tests (FITs) for hemoglobin (Hb) are increasingly used for colorectal cancer (CRC) screening. Most FIT manufacturers instruct that fecal samples from multiple parts of one bowel movement should be obtained. Our aim was to compare the FIT diagnostic performance based on fecal samples from just one versus two different sites of one bowel movement. A total of 1141 participants of screening colonoscopy provided two fecal samples from two different sites of a single bowel movement for FIT analyses. There was no statistically significant difference in the diagnostic performance of the FIT when either one or both fecal samples were used for analysis, with area under the curve (AUC) for detecting CRC ranging from 0.94 (95% confidence interval (CI) 0.84–0.99) for one FIT to 0.95 (95%CI 0.86–0.99) for a geometric mean of two FITs. The manufacturers’ recommendation of sampling multiple sites of the stool aims to reduce intra-individual Hb variability and improve diagnostic performance. If no such improvement can be achieved, the recommendation for multiple-site sampling might have potential adverse effects on population adherence to FIT-based CRC screening. Our results point to a potential of increasing adherence to FIT screening by simplifying instructions for fecal sampling at no loss of the diagnostic performance. View Full-Text
Keywords: colorectal neoplasms; early detection of cancer; fecal immunochemical tests; fecal sample colorectal neoplasms; early detection of cancer; fecal immunochemical tests; fecal sample
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MDPI and ACS Style

Amitay, E.L.; Gies, A.; Weigl, K.; Brenner, H. Fecal Immunochemical Tests for Colorectal Cancer Screening: Is Fecal Sampling from Multiple Sites Necessary? Cancers 2019, 11, 400. https://doi.org/10.3390/cancers11030400

AMA Style

Amitay EL, Gies A, Weigl K, Brenner H. Fecal Immunochemical Tests for Colorectal Cancer Screening: Is Fecal Sampling from Multiple Sites Necessary? Cancers. 2019; 11(3):400. https://doi.org/10.3390/cancers11030400

Chicago/Turabian Style

Amitay, Efrat L.; Gies, Anton; Weigl, Korbinian; Brenner, Hermann. 2019. "Fecal Immunochemical Tests for Colorectal Cancer Screening: Is Fecal Sampling from Multiple Sites Necessary?" Cancers 11, no. 3: 400. https://doi.org/10.3390/cancers11030400

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