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Updated: Apr 22, 2026
Evaluation of Colorectal Cancer Risk and Prevalence by Stool DNA Integrity Detection
Published on: June 8, 2020
Factors associated with false-positive and false-negative fecal immunochemical test results for colorectal cancer
Martin C S Wong1, Jessica Y L Ching2, Victor C W Chan2
1Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China; School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China.
Background:
Certain subgroups have higher rates of false fecal immunochemical test (FIT) results, yet few studies have addressed this topic.
Objective:
To identify demographic factors associated with false-positive and false-negative FIT results in colorectal cancer screening.
Design:
Retrospective database review of prospectively collected data.
Setting:
A bowel cancer screening center in Hong Kong invited participants for colorectal cancer screening (2008-2012).
Patients:
Study participants who underwent both FIT and colonoscopy in the first year (n = 4482) and underwent colonoscopy after negative FIT results for 3 consecutive years (n = 857).
Main Outcome Measurements:
The diagnostic accuracy and predictive values of FIT according to participant characteristics.
Results:
The sensitivity, specificity, positive predictive values, and negative predictive values for advanced neoplasia were 33.1%, 91.9%, 19.0%, and 96.0%, respectively. Participants 66 to 70 years of age had higher sensitivity, whereas older age, smoking, and use of aspirin/nonsteroidal anti-inflammatory drugs were associated with lower specificity. The rates of false-positive and false-negative results were 8.1% and 66.9%, respectively. Older age (66-70 years; adjusted odds ratio [AOR] 1.95; 95% confidence interval [CI], 1.35-2.81; P < .001), smoking (AOR 1.68; 95% CI, 1.08-2.61; P = .020), and the presence of polypoid adenoma (AOR 1.71; 95% CI, 1.14-2.57; P = .009) were associated with false-positive results. Younger participants (AOR for elderly participants 0.31) and the use of aspirin/nonsteroidal anti-inflammatory drugs (AOR 4.44) in participants with 1 FIT with negative results and the absence of high-grade dysplasia (AOR for presence 0.41) were associated with false-negative results.
Limitations:
Self-referred participants who received one type of qualitative FIT.
Conclusion:
These findings could be used to target screening more toward those with a higher risk of false-negative results and those with a lower risk of false-positive results for earlier colonoscopy.
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