"假阳性"便测试真正意味着什么? 来自新罕布什尔州结肠镜注册表的数据
Lynn F Butterly1,2,3, William M Hisey2,3, Christina M Robinson2,3
1Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
Preventive medicine reports
|July 14, 2023
概括
优化结直肠癌查需要了解便测试的准确性. 对阳性结肠镜检查结果的不同定义显著影响了假发现率和便DNA和FIT测试的阳性预测值.
科学领域:
- 胃肠病学 胃肠病学
- 在瘤学瘤学.
- 预防医学 预防医学
背景情况:
- 结肠直肠癌 (CRC) 查测试,如便DNA (mt-sDNA) 和便免疫化学测试 (FIT),对于早期检测至关重要.
- 了解这些测试的准确性,特别是它们的错误发现率 (FDR) 和正预测值 (PPV),对于优化它们的临床实用性至关重要.
- 之前的分析没有全面评估FDR和PPV在便CRC查后"阳性"结肠镜的各种定义.
研究的目的:
- 计算和比较mt-sDNA和FIT测试的错误发现率 (FDR) 和积极预测值 (PPV),使用三种不同的正确结肠镜定义.
- 为了提供对在结肠镜检查中出现错误阳性结果的全面了解,在结肠镜检查中出现阳性便测试后进行CRC查.
- 通过澄清阳性结果的意义,为最佳使用mt-sDNA和FIT测试提供信息.
主要方法:
- 使用基于人口的新罕布什尔州结肠镜注册表进行数据分析.
- 基于三个"积极"的结肠镜定义计算了mt-sDNA和FIT队列的FDR和PPV:DeeP-C研究标准,美国多社会工作组 (USMSTF) 后续指南和"临床显著"的复合定义.
- 分析了549名mt-sDNA阳性和410名FIT阳性患者的数据.
主要成果:
- 最严格的定义 (DeeP-C) 产生了高的FDR:mt-sDNA的71.9%和FIT的81.7%.
- 更广泛的定义,包括USMSTF指南和临床显著发现,大幅降低了FDR至33.2% (mt-sDNA) 和47.6% (FIT),并进一步降至32.2% (mt-sDNA) 和47.1% (FIT).
- 相应地,随着更广泛的定义,PPV增加了,在使用最全面的"临床显著"标准时,mt-sDNA达到67.8%,FIT达到52.9%.
结论:
- 阳性结肠镜术的定义显著影响CRC查便试验结果的解释.
- 采用更广泛的定义,涵盖更广泛的癌前发现,大大降低了错误发现率,并增加了mt-sDNA和FIT的积极预测值.
- 这些发现为CRC查测试的性能提供了关键的见解,并可以指导临床实践,以更有效地检测结直肠癌.
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