Sensitivity of immunochemical fecal occult blood test to small colorectal adenomas

Am J Gastroenterol. 2007 Oct;102(10):2259-64. doi: 10.1111/j.1572-0241.2007.01404.x. Epub 2007 Jul 7.


Background: Although the immunochemical fecal occult blood test (FOBT) is reportedly more sensitive to large adenomas or colorectal cancer (CRC) than the guaiac-based FOBT, the sensitivity of the immunochemical FOBT to small adenomas has scarcely been reported. Previous reports have indicated that the guaiac-based FOBT can detect small adenomas only by serendipity.

Objectives: To investigate the sensitivity of immunochemical FOBT to small adenomas using a large-scale cohort.

Methods: We analyzed 21,805 consecutively enrolled asymptomatic persons who underwent colonoscopy and immunochemical FOBT.

Results: The sensitivity to adenomas </=9 mm was significantly higher than the false-positive rate as revealed by analysis of all eligible subjects (7.0%vs 4.5%, P < 0.001). In men, the sensitivity was superior to the false-positive rate and increased with age (<50 yr 6.1% and >60 yr 11.3%). On the other hand, the sensitivity in women was not significantly different from the false-positive rate in any generation (5.1%vs 4.7% for all eligible women, P= 0.72).

Conclusions: Immunochemical FOBT detected a small percentage of small adenomas in men at a rate that is significantly higher than the false-positive rate. Studies comparing the guaiac and immunochemical FOBTs using the end point of CRC-related death are expected.

MeSH terms

  • Adenoma / diagnosis*
  • Adenoma / pathology
  • Adult
  • Cohort Studies
  • Colonoscopy
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / pathology
  • Female
  • Humans
  • Immunochemistry
  • Male
  • Middle Aged
  • Occult Blood*
  • Sensitivity and Specificity