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Detection of colorectal cancer in symptomatic outpatients without visible rectal bleeding: Validity of the fecal occult blood test

Authors Bjerregaard NC, Tøttrup A, Sørensen HT, Laurberg S

Published 21 September 2009 Volume 2009:1 Pages 119—124


Review by Single anonymous peer review

Peer reviewer comments 2

Niels Christian Bjerregaard1, Anders Tøttrup1, Henrik Toft Sørensen2, Søren Laurberg1

1Department of Surgery P, Aarhus Sygehus, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark; 2Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark

Background: In 2002, a new diagnostic strategy in symptomatic outpatients without known established colorectal cancer risk factors aged 40 years or older was implemented in Denmark. Fecal occult blood test (Hemoccult Sensa®) was a part of that strategy in patients without visible rectal bleeding.

Aims: The aim was to assess the validity of the Hemoccult Sensa® test in detecting colorectal cancer in the above-mentioned outpatients.

Patients: Symptomatic outpatients without known established colorectal cancer risk factors and without visible rectal bleeding.

Methods: Hemoccult Sensa® was performed before endoscopic examination. Colorectal cancer was identified at histopathological examination. Patients completed a questionnaire about their symptoms before their first hospital appointment.

Results: Eight of 256 patients were found to have colorectal cancer. Median patient age was 63 years. The positive predictive value, negative predictive value, sensitivity, and specificity of Hemoccult Sensa® for colorectal cancer were 10.5% (95% confidence interval [CI]: 6.8–14.3), 99.0% (95% CI: 97.8–100.0), 75.0% (95% CI: 69.7–80.3), and 79.4% (95% CI: 74.5–84.4).

Conclusions: Hemoccult Sensa® as the initial examination in symptomatic outpatients without known established colorectal cancer risk factors presenting without rectal bleeding has to be used with caution. We did not find Hemoccult Sensa® test to be an acceptable alternative to flexible sigmoidoscopy.

Keywords: colorectal neoplasms, occult blood, diagnostic tests, sensitivity, specificity

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