Chandrapalan, Subashini, Bosch, Sofie, Cubiella, Joaquín, Guardiola, Jordi, Kimani, Peter K., Mulder, Chris, Persaud, Krishna, de Meij, Tim G. J., Altomare, Donato F., Brenner, Herman, de Boer, Nanne K. H., Ricciardiello, Luigi and Arasaradnam, Ramesh P. (2021) Systematic review with meta‐analysis : volatile organic compound analysis to improve faecal immunochemical testing in the detection of colorectal cancer. Alimentary Pharmacology & Therapeutics, 54 (1). pp. 14-23. doi:10.1111/apt.16405 ISSN 0269-2813.

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Abstract

Summary: Background: Faecal immunochemical test (FIT) is emerging as a valid test to rule‐out the presence of colorectal cancer (CRC). However, the accuracy of FIT is dependent on the cut‐off applied. An additional low‐cost test could improve further detection of CRC. Aims: To evaluate the efficacy of combined FIT and volatile organic compounds (VOC) in the detection of CRC within symptomatic populations. Methods: Systematic reviews on the diagnostic accuracy of FIT and VOC, for the detection of CRC, were updated. Meta‐analyses were performed adopting a bivariate model for sensitivity and specificity. Clinical utility of combined FIT and VOC was estimated using Fagan's nomogram. Post‐test probability of FIT negatives was used as a pre‐test probability for VOC. Results: The pooled sensitivity and specificity of FIT at 10 µg/g faeces, for the detection of CRC, were 0.914 (95% confidence interval [CI] = 0.894‐0.936) and 0.783 (CI = 0.850‐0.696), respectively. For VOC, the sensitivity was 0.837 (CI = 0.781‐0.881) and the specificity was 0.803 (CI = 0.870‐0.712). The area under the curve for FIT and VOC were 0.926 and 0.885, respectively. In a population with 5% CRC prevalence, the estimated probability of having CRC following a negative FIT was 0.5% and following both negative FIT and VOC was 0.1%. Conclusions: In a FIT‐negative symptomatic population, VOC can be a good test to rule‐out the presence of CRC. The estimated probability reduction by 0.4% when both tests being negative offers adequate safety netting in primary care for the exclusion of CRC. The number needed to colonoscope to identify one CRC is eight if either FIT or VOC positive. Cost‐effectiveness and clinical accuracy of this approach will need further evaluation.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General) R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
SWORD Depositor:	Library Publications Router
Library of Congress Subject Headings (LCSH):	Systematic reviews (Medical research), Systematic reviews (Medical research) -- Evaluation, Colon (Anatomy) -- Cancer, Meta-analysis
Journal or Publication Title:	Alimentary Pharmacology & Therapeutics
Publisher:	Wiley-Blackwell Publishing Ltd.
ISSN:	0269-2813
Official Date:	July 2021
Dates:	Date Event July 2021 Published 18 May 2021 Available 24 April 2021 Accepted
Volume:	54
Number:	1
Page Range:	pp. 14-23
DOI:	10.1111/apt.16405
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	22 June 2021
Date of first compliant Open Access:	22 June 2021
Related URLs:	http://creativecommons.org/licenses/by-n...

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