Identification of colorectal adenomas by a quantitative immunochemical faecal occult blood screening test depends on adenoma characteristics, development threshold used and number of tests performed

Aliment Pharmacol Ther. 2009 Apr 15;29(8):906-17. doi: 10.1111/j.1365-2036.2009.03946.x.


Background: Faecal occult blood tests (FOBT) are faulted by low sensitivity for advanced adenomatous polyps (AAP). Quantified, immunochemical, haemoglobin (Hb)-specific immunochemical FOBT (I-FOBT) measurements are now used for colorectal screening.

Aims: To correlate adenoma characteristics to amount of faecal Hb lost and to evaluate sensitivity and specificity for AAP by faecal Hb development threshold used and number of I-FOBTs collected.

Methods: Three daily I-FOBTs were collected and analysed in 1221 patients scheduled for colonoscopy. Faecal Hb was analysed as ngHb/mL of buffer and the highest result related to colonoscopy findings.

Results: In 1204 patients without cancer, colonoscopy identified adenomas in 294, 99 with AAPs. Adenoma patients had elevated faecal Hb increasing with advanced histology, size, pedunculated shape and multiplicity (P < 0.001 for all). At 50 ngHb/mL threshold, sensitivity and specificity for AAPs were 54.5% (95%CI 44.7, 64.7) and 88.1% (95%CI 86.2, 90.1) for three tests. At higher thresholds, sensitivity decreased, but was significantly higher with more samples collected. Conversely, specificity increased at higher thresholds, but decreased with more samples.

Conclusions: Faecal Hb loss from adenomas is significantly associated with size, number and advanced features. Sensitivity and specificity for AAPs are determined by test threshold chosen and number of samples collected; these determine the number of colonoscopies needed for positive tests.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenoma / diagnosis*
  • Adenomatous Polyps
  • Aged
  • Colonic Polyps / chemistry
  • Colonic Polyps / diagnosis*
  • Colonoscopy / methods
  • Colorectal Neoplasms / chemistry
  • Colorectal Neoplasms / diagnosis*
  • Feces / chemistry
  • Female
  • Hemoglobins / analysis*
  • Humans
  • Immunohistochemistry / methods*
  • Male
  • Mass Screening / methods
  • Middle Aged
  • Occult Blood*
  • Predictive Value of Tests
  • Sensitivity and Specificity


  • Hemoglobins