Evaluation of a fecal occult blood test with reverse passive hemagglutination for colorectal neoplasm screening

To evaluate the one and three sampling reverse passive hemagglutination fecal occult blood test (RPHA FOBT) for colorectal neoplasm screening.

A group of 3034 individuals with histories of colorectal polyps and/or ulcers were screened for colorectal cancer. Three day fecal samples were collected and 60 cm fiberoptic colonoscopy was conducted for each subject. The fecal samples were tested for occult blood with the RPHA method and the endoscopic and histopathological diagnoses were used as standard reference for evaluation. The sensitivity, specificity and positive and negative predictive values of different samplings were compared.

About 521 cases of colorectal neoplasms were detected, including 12 cases of colorectal cancer and 509 cases of polyps. Results showed that the mean sensitivity of one sampling RPHA FOBT for colorectal neoplasm was only 13.2%, the specificity was 90.3% and the positive and negative predictive values were 21.3% and 83.4%, respectively; while for the three sampling, taking one positivity as positive, the sensitivity increased to 22.0%, the specificity decreased to 81.6% and the positive and negative predictive values were 19.7% and 83.6%, respectively.

A single RPHA FOBT seems to be less sensitive for screening for colorectal neoplasms. Since it is convenient and economical, RPHA FOBT remains the most practical procedure for detection of early colorectal cancer and polyps if it is combined with other screening methods.