What are the test characteristics of a single fecal immunochemical test to detect colorectal cancer and advanced adenoma?

A single fecal immunochemical test (FIT) is good for both ruling out colorectal cancer (CRC) and, if a higher threshold is used, for ruling in CRC. Its ability to rule out advanced ademona, though, is low. (LOE = 1a)

Imperiale TF, Gruber R, Stump TE, Emmett TW, Monahan PO. Performance characteristics of fecal immunochemical tests for colorectal cancer and advanced adenomatous polyps. A systematic review and meta-analysis. Ann Intern Med 2019;170:319-329.  [PMID:30802902]

Meta-analysis (other)

Foundation

Various (meta-analysis)

These authors identified 31 studies (N = 120,255 patients) by searching 4 databases and the reference lists of retrieved articles. Two reviewers independently selected English-language only studies for inclusion, extracted the data, and evaluated study quality. The quality of the studies was high. Test characteristics vary by the cutoff used by the manufacturer. At a cutoff of 10 mcg/g, sensitivity (the ability to rule out CRC) is .91 with a negative likelihood ratio of .1. At a higher threshold (20 mcg/g), specificity (the ability to rule in CRC) is higher (.95) and the positive likelihood ratio is 15.49. For advanced adenoma, sensitivity is low (.4) at 10 mcg/g; specificity was better (.95) at 20 mcg/g, though the positive likelihood ratio was only 5.86.