ความแม่นยำของการตรวจซ้ำหาเลือดแฝงในอุจจาระสำหรับการคัดกรองโรคมะเร็งลำไส้ใหญ่และไส้ตรง ในโรงพยาบาลแม่ระมาด จังหวัดตาก

Adulkrit Nata

Authors

Adulkrit Nata Mae Ramat Hospital, Tak Province

Keywords:

Colorectal cancer, Screening, Fecal immunochemical test, Colonoscopy, Diagnostic accuracy, Triage

Abstract

Colorectal cancer remains a major public health concern worldwide. Although screening with the Fecal Immunochemical Test (FIT) improves the detection of early-stage disease, its diagnostic accuracy remains limited. Additionally, colonoscopy-based screening is constrained by limited resources and shortages of endoscopists. Repeat fecal immunochemical testing (Repeat FIT) may improve the performance of colorectal cancer screening. This study aimed to evaluate the diagnostic accuracy of colorectal cancer screening using Repeated FIT. A prospective study was conducted among individuals aged 50–70 years who had a positive initial FIT result between October 1, 2024, and March 31, 2026. All participants underwent Repeat FIT testing followed by colonoscopy. The diagnostic performance of Repeat FIT was assessed by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and the area under the receiver operating characteristic curve (AUC-ROC).

A total of 112 participants were enrolled, including 34 individuals with positive Repeat FIT results and 78 with negative Repeat FIT results. All participants subsequently underwent colonoscopy. Among the Repeat FIT–positive group (FIT pos/pos), 24 participants had positive colonoscopy findings, accounting for 70.59%. In the Repeat FIT–negative group (FIT pos/neg), positive colonoscopy findings were observed in 22 participants (28.21%). The difference between the two groups was statistically significant (p<0.001). The diagnostic performance of Repeat FIT was evaluated among participants with an initial positive FIT result, using colonoscopy findings as the reference standard. Repeat FIT demonstrated a specificity of 84.80%, PPV of 70.60%, sensitivity of 52.20%, accuracy of 71.40%, and an AUC-ROC of 0.69 (95%CI: 0.60–0.77). Repeat FIT in individuals with an initial positive FIT result may therefore serve as a triage tool for prioritizing colonoscopy and may help support the development of colorectal cancer screening strategies in resource-limited settings with shortages of endoscopists. However, the sensitivity of Repeat FIT was only moderate; therefore, additional clinical risk factors should be considered alongside screening results to improve diagnostic coverage and reduce missed diagnoses.

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