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Colorectal Dis

Title:		Risk stratification of symptomatic patients suspected of colorectal cancer using faecal and urinary markers
Author(s):		Widlak MM; Neal M; Daulton E; Thomas CL; Tomkins C; Singh B; Harmston C; Wicaksono A; Evans C; Smith S; Savage RS; Covington JA; Arasaradnam RP;
Address:		"Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK. Medical School, University of Warwick, Coventry, UK. Department of Statistics, University of Warwick, Coventry, UK. School of Engineering, University of Warwick, Coventry, UK. Department of Biochemistry, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK. Department of Colorectal Surgery, Leicester General Hospital, Leicester, UK. Department of Colorectal Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK. Midlands and North West Bowel Cancer Screening Hub, University Hospitals Coventry and Warwickshire, Coventry, UK. Applied Biological and Experimental Sciences, University of Coventry, Coventry, UK"
Journal Title:		Colorectal Dis
Year:		2018
Volume:		20181017
Issue:		12
Page Number:		O335 - O342
DOI:		10.1111/codi.14431
ISSN/ISBN:		1463-1318 (Electronic) 1462-8910 (Linking)
Abstract:		"AIM: Faecal markers, such as the faecal immunochemical test for haemoglobin (FIT) and faecal calprotectin (FCP), have been increasingly used to exclude colorectal cancer (CRC) and colonic inflammation. However, in those with lower gastrointestinal symptoms there are considerable numbers who have cancer but have a negative FIT test (i.e. false negative), which has impeded its use in clinical practice. We undertook a study of diagnostic accuracy CRC using FIT, FCP and urinary volatile organic compounds (VOCs) in patients with lower gastrointestinal symptoms. METHOD: One thousand and sixteen symptomatic patients with suspected CRC referred by family physicians were recruited prospectively in accordance with national referring protocol. A total of 562 patients who completed colonic investigations, in addition to providing stool for FIT and FCP as well as urine samples for urinary VOC measurements, were included in the final outcome measures. RESULTS: The sensitivity and specificity for CRC using FIT was 0.80 [95% confidence interval (CI) 0.66-0.93] and 0.93 (CI 0.91-0.95), respectively. For urinary VOCs, the sensitivity and specificity for CRC was 0.63 (CI 0.46-0.79) and 0.63 (CI 0.59-0.67), respectively. However, for those who were FIT-negative CRC (i.e. false negatives), the addition of urinary VOCs resulted in a sensitivity of 0.97 (CI 0.90-1.0) and specificity of 0.72 (CI 0.68-0.76). CONCLUSIONS: When applied to the FIT-negative group, urinary VOCs improve CRC detection (sensitivity rises from 0.80 to 0.97), thus showing promise as a second-stage test to complement FIT in the detection of CRC"
Keywords:		"Adult Aged Aged, 80 and over Biomarkers, Tumor/analysis Colon Colorectal Neoplasms/*diagnosis Early Detection of Cancer/*methods Feces/*chemistry Female Hemoglobins/analysis Humans Leukocyte L1 Antigen Complex/*analysis Male Middle Aged Occult Blood Prosp;"
Notes:		"MedlineWidlak, M M Neal, M Daulton, E Thomas, C L Tomkins, C Singh, B Harmston, C Wicaksono, A Evans, C Smith, S Savage, R S Covington, J A Arasaradnam, R P eng Clinical Trial England 2018/09/25 Colorectal Dis. 2018 Dec; 20(12):O335-O342. doi: 10.1111/codi.14431. Epub 2018 Oct 17"