The Relative Effectiveness of Fecal Hemoglobin, Transferrin, Calprotectin and Lactoferrin Screening to Detect Colorectal Cancer Compared with Colonoscopy

Abstract

Colonoscopy screening and fecal biomarker testing have often been used in screening for colorectal cancer (CRC). However, the sensitivity varied considerably across different fecal biomarkers and quantity or quality of the test assays. The aim of the present study was to evaluate the relative efficacy of fecal immunochemical tests for human hemoglobin (hHb), transferrin (hTf), calprotectin (hCp) and lactoferrin (hLf) as well as serum CEA for colorectal cancer screening with the gold standard, colonoscopy. In this case-control of 281 patients who underwent colonoscopy, cases (n = 139) were clinically suspected patients who were matched with healthy individuals without colorectal cancer (control group) (n = 142). A fecal sample was obtained on the day before colonoscopy and all subjects underwent diagnostic colonoscopy with biopsy confirmation. The sensitivity of hHb, hTf, hCp, and hLf tests for CRC were 100.0%, 97.1%, 100.0% and 82.9%, respectively. The specificity of hHb, hTf, hCp, and hLf tests were 70.3%, 59.4%, 36.6% and 87.0%, respectively. If more than one tests were considered positive, the positive rates rose to 100% in the CRC. Patients who had hHb or hLf positive were more likely to have CRC than the patients who had hHb or hLf negative (adjusted odds ratio [aOR] = 28.8, P = 0.002 and aOR = 15.4, P < 0.001, respectively). In conclusion, fecal hHb and hLf were found useful in the detection of CRC in symptomatic patients. Any combination of these four fecal biomarkers appears to increase the sensitivity and provides a better diagnostic accuracy, compared to any of the single biomarkers among these patients.