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Comparative Performance of Common Fecal Immunochemical Tests : A Cross-Sectional Study.

Barcey T Levy1, Yinghui Xu2, Jeanette M Daly2

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Fecal immunochemical tests (FITs) for colorectal cancer screening vary significantly in performance. These tests should not be considered interchangeable due to differences in sensitivity and specificity for detecting advanced colorectal neoplasia.

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Area of Science:

  • Gastroenterology
  • Oncology
  • Diagnostic Medicine

Background:

  • Fecal immunochemical tests (FITs) are widely used for colorectal cancer (CRC) screening.
  • Limited data exist to guide the selection of specific FIT brands for optimal screening.

Purpose of the Study:

  • To compare the performance characteristics of five commonly used FITs for colorectal cancer screening.
  • To evaluate sensitivity and specificity of different FITs using colonoscopy as the reference standard.

Main Methods:

  • A cross-sectional study involving 3761 participants aged 50-85 undergoing colonoscopy.
  • Participants completed five different FITs; performance was assessed against colonoscopy findings for advanced colorectal neoplasia (ACN).

Main Results:

  • Test positivity rates varied four-fold across FITs, from 3.9% to 16.4%.
  • Sensitivity for ACN ranged from 10.1% to 36.7%, and specificity from 85.5% to 96.6%.
  • Significant differences in sensitivity and specificity were observed between most FIT brands.

Conclusions:

  • Fecal immunochemical tests (FITs) exhibit variable performance in detecting advanced colorectal neoplasia.
  • Different FIT brands are not interchangeable and test selection may impact screening effectiveness.