Multitarget FIT better than standard test for colorectal cancer screening

A multitarget faecal immunochemical test (mtFIT) is more accurate than conventional FIT in detecting advanced neoplasia due to an increased detection of advanced adenomas, according to a study.

This diagnostic test accuracy study in a colonoscopy-controlled series sought to develop an mtFIT with better diagnostic performance than FIT. A total of 1,284 individuals from a screening (n=1,038) and referral (n=246) population were classified by their most advanced lesion (colorectal cancer [CRC; n=47], advanced adenoma [n=135], advanced serrated polyp [n=30], nonadvanced adenoma [n=250], and nonadvanced serrated polyp [n=53]), along with control participants (n=769).

The authors developed and applied antibody-based assays to leftover FIT material, as well as applied classification and regression tree (CART) analysis to biomarker concentrations to identify the best combination for detecting advanced neoplasia. Finally, they cross-validated the performance of this combination (mtFIT) using a leave-one-out approach and compared with FIT at equal specificity.

In the CART analysis, a combination of haemoglobin, calprotectin, and serpin family F member 2—the mtFIT—demonstrated a cross-validated sensitivity for advanced neoplasia of 42.9 percent (95 percent confidence interval [CI], 36.2–49.9 percent) vs 37.3 percent (95 percent CI, 30.7–44.2 percent) for FIT (p=0.025), with equal specificity of 96.6 percent. The cross-validated sensitivity for advanced adenomas increased from 28.2 percent (95 percent CI, 20.8–36.5 percent) to 37.8 percent (95 percent CI, 29.6–46.5 percent; p=0.006).

Based on these findings, “early health technology assessment indicated that mtFIT-based screening could be cost-effective compared with FIT,” the authors said. “A prospective screening trial is in preparation.”

The study was limited by participants enriched with persons from a referral population.