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Lowering Fecal Immunochemical Test Positivity Threshold vs Multitarget Stool RNA Testing for Colorectal Cancer Screening | Colorectal Cancer | JAMA | 西瓜视频

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Research Letter
闯耻苍别听1, 2024

Lowering Fecal Immunochemical Test Positivity Threshold vs Multitarget Stool RNA Testing for Colorectal Cancer Screening

Author Affiliations
  • 1Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
  • 2Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
  • 3Heidelberg Medical Faculty, Heidelberg University, Heidelberg, Germany
  • 4German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
JAMA. Published online June 1, 2024. doi:10.1001/jama.2024.9289

Fecal immunochemical tests (FITs) for hemoglobin are the most widely used screening tests for colorectal cancer (CRC) globally.1 However, they have limited sensitivity in detecting early-stage CRC and CRC precursors.2 In 2023, the CRC-PREVENT study, a blinded, prospective, cross-sectional study that enrolled the target population for CRC screening, demonstrated increased sensitivity for CRC of a multitarget stool RNA (mt-sRNA) test compared with FIT alone (94% vs 78%). The mt-sRNA test incorporated a commercially available FIT (iFOBT OC-Auto; positivity threshold, 20 渭g hemoglobin per gram of feces), concentration of 8 RNA transcripts, and participant-reported smoking status.3 However, this increase in sensitivity came at a substantial loss of specificity for no lesions compared with FIT alone (88% vs 96%). This analysis evaluated whether comparable levels of sensitivity and specificity could be achieved by lowering the FIT positivity threshold, without additional stool RNA testing and smoking assessment.

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