The role of faecal calprotectin in the identification of colorectal neoplasia in patients attending for screening colonoscopy

Ross, F. A., Park, J. H. , Mansouri, D. , Little, C., Di Rollo, D. G., Combet, E. , Van Wyk, H. , Horgan, P. G. , McMillan, D. C. and Roxburgh, C. S. D. (2022) The role of faecal calprotectin in the identification of colorectal neoplasia in patients attending for screening colonoscopy. Colorectal Disease, 24(2), pp. 188-196. (doi: 10.1111/codi.15942) (PMID:34614299)

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Abstract

Aim: Although the relationship between colorectal neoplasia and inflammation is well described, the role of faecal calprotectin (FC) in clinical practice to diagnose or screen patients for colorectal neoplasia is less defined. This prospective study characterizes the relationship between FC and colorectal neoplasia in patients within the faecal occult blood testing (FOBT) positive patients in the Scottish Bowel Screening Programme. Methods: All FOBT positive patients attending for colonoscopy between February 2016 and July 2017 were invited to participate. Patients provided a stool sample for FC before commencing bowel preparation. All demographics and endoscopic findings were collected prospectively. Results: In all, 352 patients were included. 210 patients had FC > 50 µg. Colorectal cancer (CRC) patients had a higher median FC (138.5 μg/g, P < 0.05), in comparison to those without CRC, and 13/14 had an FC > 50 µg/g (93%). FC had a high sensitivity (92.8%) and negative predictive value (99.3%) for CRC, but with a low specificity (41.7%) and positive predictive value (6.2%). FC sensitivity increased sequentially as neoplasms progressed from non-advanced to malignant neoplasia (48.6% non-advanced adenoma vs. 92.9% CRC). However, no significant relationship was observed between FC and non-cancer neoplasia. Conclusion: In an FOBT positive screening population, FC was strongly associated with CRC (sensitivity 92.8%, specificity 41.7% for CRC, at 50 µg/g). However, although sensitive for the detection of CRC, FC failed to show sufficient sensitivity or specificity for the detection of non-cancer neoplasia. Based on these results we cannot recommend routine use of FC in a bowel screening population to detect cancer per se, but it is apparent that, with further optimization, faecal assessments including quantification of haemoglobin and inflammation could form part of a risk assessment tool aimed at refining the selection of patients for colonoscopy in both symptomatic and screening populations.

Item Type:Articles
Keywords:Gastroenterology
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Park, Mr James and Mansouri, Mr David and Little, Dr Cariss and Horgan, Professor Paul and McMillan, Professor Donald and Di Rollo, Domenic and Ross, Dr Fiona and Roxburgh, Professor Campbell and Van Wyk, Dr Hester and Combet Aspray, Professor Emilie
Authors: Ross, F. A., Park, J. H., Mansouri, D., Little, C., Di Rollo, D. G., Combet, E., Van Wyk, H., Horgan, P. G., McMillan, D. C., and Roxburgh, C. S. D.
College/School:College of Medical Veterinary and Life Sciences > School of Cancer Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Colorectal Disease
Publisher:Wiley
ISSN:1462-8910
ISSN (Online):1463-1318
Published Online:02 November 2021

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