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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
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 | |||||||||
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| 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 |
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| 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: |
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| 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: |
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