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Risk stratification of symptomatic patients suspected of colorectal cancer using faecal and urinary markers

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Widlak, Monika, Neal, Matthew, Daulton, Emma, Thomas, Claire L., Tomkins, Claudia, Singh, Baljit, Harmston, Christopher , Wicaksono, Alfian, Evans, Charles, Smith, Steve, Savage, Richard S., Covington, James A. and Arasaradnam, Ramesh P. (2018) Risk stratification of symptomatic patients suspected of colorectal cancer using faecal and urinary markers. Colorectal Disease, 20 (12). O335-O342. doi:10.1111/codi.14431 ISSN 1462-8910.

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Official URL: https://doi.org/10.1111/codi.14431

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Abstract

Aim

Faecal markers, such as the faecal immunochemical test for haemoglobin (FIT) and faecal calprotectin (FCP), have been increasingly used to exclude colorectal cancer (CRC) and colonic inflammation. However, in those with lower gastrointestinal symptoms there are considerable numbers who have cancer but have a negative FIT test (i.e. false negative), which has impeded its use in clinical practice. We undertook a study of diagnostic accuracy CRC using FIT, FCP and urinary volatile organic compounds (VOCs) in patients with lower gastrointestinal symptoms.

Method

One thousand and sixteen symptomatic patients with suspected CRC referred by family physicians were recruited prospectively in accordance with national referring protocol. A total of 562 patients who completed colonic investigations, in addition to providing stool for FIT and FCP as well as urine samples for urinary VOC measurements, were included in the final outcome measures.

Results

The sensitivity and specificity for CRC using FIT was 0.80 [95% confidence interval (CI) 0.66–0.93] and 0.93 (CI 0.91–0.95), respectively. For urinary VOCs, the sensitivity and specificity for CRC was 0.63 (CI 0.46–0.79) and 0.63 (CI 0.59–0.67), respectively. However, for those who were FIT‐negative CRC (i.e. false negatives), the addition of urinary VOCs resulted in a sensitivity of 0.97 (CI 0.90–1.0) and specificity of 0.72 (CI 0.68–0.76).

Conclusions

When applied to the FIT‐negative group, urinary VOCs improve CRC detection (sensitivity rises from 0.80 to 0.97), thus showing promise as a second‐stage test to complement FIT in the detection of CRC.

Item Type: Journal Article
Subjects: R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences
Faculty of Science, Engineering and Medicine > Engineering > Engineering
Faculty of Science, Engineering and Medicine > Science > Statistics
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Colon (Anatomy) -- Cancer -- Diagnosis
Journal or Publication Title: Colorectal Disease
Publisher: Wiley-Blackwell Publishing, Inc.
ISSN: 1462-8910
Official Date: December 2018
Dates:
DateEvent
December 2018Published
24 September 2018Available
17 September 2018Accepted
Volume: 20
Number: 12
Page Range: O335-O342
DOI: 10.1111/codi.14431
Status: Peer Reviewed
Publication Status: Published
Reuse Statement (publisher, data, author rights): "This is the peer reviewed version of the following article: Widlak, M. M., Neal, M. , Daulton, E. , Thomas, C. L., Tomkins, C. , Singh, B. , Harmston, C. , Wicaksono, A. , Evans, C. , Smith, S. , Savage, R. S., Covington, J. A. and Arasaradnam, R. P. (2018), Risk stratification of symptomatic patients suspected of colorectal cancer using faecal and urinary markers. Colorectal Dis., which has been published in final form at https://doi.org/10.1111/codi.14431. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions."
Access rights to Published version: Open Access (Creative Commons)
Date of first compliant deposit: 21 September 2018
Date of first compliant Open Access: 14 November 2018
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
UNSPECIFIEDBowel Disease Research Foundationhttp://dx.doi.org/10.13039/501100000863
UNSPECIFIEDAlphalabsUNSPECIFIED
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