Fecal Immunochemical Test Detects Sessile Serrated Adenomas and Polyps With a Low Level of Sensitivity

Published:August 04, 2016DOI:

      Background & Aims

      The serrated pathway is a distinct pathway of colorectal carcinogenesis that has been implicated in development of a substantial proportion of interval colorectal cancers. The fecal immunochemical test (FIT) detects early neoplasms with a higher level of sensitivity than the guaiac test. We investigated the sensitivity of the FIT in detection of sessile serrated adenomas/polyps (SSA/Ps).


      We performed a prospective study of 6198 asymptomatic subjects (mean age, 59.0 ± 7.0 years) who received concurrent screening colonoscopies and FITs at the Health Management Center of National Taiwan University Hospital from August 2010 through November 2014. The sensitivity of FIT for conventional adenoma, advanced adenoma, and SSA/P at different cutoffs was calculated, and results were compared by using multivariate analysis adjusted for potential confounders.


      Prevalence values of SSA/P, adenoma, and advanced adenoma were 1.4%, 20.2%, and 5.5%, respectively. At cutoffs of 10, 15, and 20 μg hemoglobin/g feces, the FIT detected all SSA/Ps with 12.3%, 6.2%, and 6.2% sensitivity, large SSA/Ps with 18.4%, 10.5%, and 10.5% sensitivity, and advanced adenomas with 32.4%, 24.5%, and 20.9% sensitivity, respectively. Multivariate analysis revealed that positive results from the FIT did not differ significantly between individuals with SSA/P and those with non-advanced adenoma or those with negative findings from colonoscopy. Patients with large SSA/Ps were less likely to have positive results from the FIT than patients with advanced adenoma, with odds ratios of 0.44 (95% confidence interval [CI], 0.18–1.05), 0.30 (95% CI, 0.10–0.90), and 0.37 (95% CI, 0.12–1.12) at cutoffs of 10, 15, and 20 μg hemoglobin/g feces, respectively, after adjusting for lesion size, even with synchronous conventional adenoma.


      In a prospective study of 6198 subjects receiving the FIT and colonoscopy, we found that the FIT detected SSA/Ps with significantly lower levels of sensitivity than conventional adenoma. Further studies are needed to determine the effects of these findings on the effectiveness of FIT-based colorectal cancer screening program.


      Abbreviations used in this paper:

      aOR (adjusted odds ratio), CE (chromoendoscopy), CI (confidence interval), CRC (colorectal cancer), FIT (fecal immunochemical test), gFOBT (guaiac fecal occult blood test), NBI (narrow band imaging), NNScope (number needed for endoscopy), NSAID (nonsteroidal anti-inflammatory drug), PPV (positive predictive value), SSA/P (sessile serrated adenoma/polyp)
      To read this article in full you will need to make a payment
      AGA Member Login
      Login with your AGA username and password.

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ferlay J.
        • Soerjomataram I.
        • Ervik M.
        • et al.
        GLOBOCAN 2012 v1.0, Cancer incidence and mortality worldwide: IARC CancerBase no. 11.
        ([Internet]) International Agency for Research on Cancer, Lyon, France2013 (Available from:) (Accessed January 12, 2016)
        • Hewitson P.
        • Glasziou P.
        • Watson E.
        • et al.
        Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update.
        Am J Gastroenterol. 2008; 103: 1541-1549
        • van Rossum L.G.
        • van Rijn A.F.
        • Laheij R.J.
        • et al.
        Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population.
        Gastroenterology. 2008; 135: 82-90
        • Schreuders E.H.
        • Ruco A.
        • Rabeneck L.
        • et al.
        Colorectal cancer screening: a global overview of existing programmes.
        Gut. 2015; 64: 1637-1649
        • Tinmouth J.
        • Lansdorp-Vogelaar I.
        • Allison J.E.
        Faecal immunochemical tests versus guaiac faecal occult blood tests: what clinicians and colorectal cancer screening programme organisers need to know.
        Gut. 2015; 64: 1327-1337
        • Graser A.
        • Stieber P.
        • Nagel D.
        • et al.
        Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population.
        Gut. 2009; 58: 241-248
        • Chiang T.H.
        • Lee Y.C.
        • Tu C.H.
        • et al.
        Performance of the immunochemical fecal occult blood test in predicting lesions in the lower gastrointestinal tract.
        CMAJ. 2011; 183: 1474-1481
        • Dekker E.
        • Sanduleanu S.
        Colorectal cancer: strategies to minimize interval CRC in screening programmes.
        Nat Rev Gastroenterol Hepatol. 2016; 13: 10-12
        • Heigh R.I.
        • Yab T.C.
        • Taylor W.R.
        • et al.
        Detection of colorectal serrated polyps by stool DNA testing: comparison with fecal immunochemical testing for occult blood (FIT).
        PLoS One. 2014; 9: e85659
        • Imperiale T.F.
        • Ransohoff D.F.
        • Itzkowitz S.H.
        • et al.
        Multitarget stool DNA testing for colorectal-cancer screening.
        N Engl J Med. 2014; 370: 1287-1297
        • Chang L.C.
        • Wu M.S.
        • Tu C.H.
        • et al.
        Metabolic syndrome and smoking may justify earlier colorectal cancer screening in men.
        Gastrointest Endosc. 2014; 79: 961-969
        • Chiu H.M.
        • Lin J.T.
        • Chen T.H.
        • et al.
        Elevation of C-reactive protein level is associated with synchronous and advanced colorectal neoplasm in men.
        Am J Gastroenterol. 2008; 103: 2317-2325
        • Chiu H.M.
        • Lee Y.C.
        • Tu C.H.
        • et al.
        Association between early stage colon neoplasms and false-negative results from the fecal immunochemical test.
        Clin Gastroenterol Hepatol. 2013; 11: 832-838.e1–e2
        • Chiu H.M.
        • Wang H.P.
        • Lee Y.C.
        • et al.
        A prospective study of the frequency and the topographical distribution of colon neoplasia in asymptomatic average-risk Chinese adults as determined by colonoscopic screening.
        Gastrointest Endosc. 2005; 61: 547-553
        • Snover D.C.
        • Ahnen D.J.
        • Burt R.W.
        • et al.
        Serrated polyps of the colon and rectum and serrated polyposis.
        in: Bosman F.T. Carneiro F. Hruban R.H. WHO classification of tumours of the digestive system. 4th ed. IARC Press, Lyon2010: 160-165
        • Snover D.C.
        Update on the serrated pathway to colorectal carcinoma.
        Hum Pathol. 2011; 42: 1-10
        • Rex D.K.
        • Ahnen D.J.
        • Baron J.A.
        • et al.
        Serrated lesions of the colorectum: review and recommendations from an expert panel.
        Am J Gastroenterol. 2012; 107 (quiz 1314, 1330): 1315-1329
        • Chiu H.M.
        • Chen S.L.
        • Yen A.M.
        • et al.
        Effectiveness of fecal immunochemical testing in reducing colorectal cancer mortality from the One Million Taiwanese Screening Program.
        Cancer. 2015; 121: 3221-3229
        • Chiang T.H.
        • Chuang S.L.
        • Chen S.L.
        • et al.
        Difference in performance of fecal immunochemical tests with the same hemoglobin cutoff concentration in a nationwide colorectal cancer screening program.
        Gastroenterology. 2014; 147: 1317-1326
        • Risio M.
        • Hassan C.
        • Sottile A.
        • et al.
        Histological features of advanced colorectal adenomas detected by endoscopy and fecal immunochemical test.
        Endoscopy. 2015; 47: 903-909
        • Gellad Z.F.
        • Stechuchak K.M.
        • Fisher D.A.
        • et al.
        Longitudinal adherence to fecal occult blood testing impacts colorectal cancer screening quality.
        Am J Gastroenterol. 2011; 106: 1125-1134
        • Lo S.H.
        • Halloran S.
        • Snowball J.
        • et al.
        Colorectal cancer screening uptake over three biennial invitation rounds in the English bowel cancer screening programme.
        Gut. 2015; 64: 282-291
        • van Roon A.H.
        • Wilschut J.A.
        • Hol L.
        • et al.
        Diagnostic yield improves with collection of 2 samples in fecal immunochemical test screening without affecting attendance.
        Clin Gastroenterol Hepatol. 2011; 9: 333-339
        • Lidgard G.P.
        • Domanico M.J.
        • Bruinsma J.J.
        • et al.
        Clinical performance of an automated stool DNA assay for detection of colorectal neoplasia.
        Clin Gastroenterol Hepatol. 2013; 11: 1313-1318
        • Hsu Y.C.
        • Chiu H.M.
        • Liou J.M.
        • et al.
        Glycated hemoglobin A1c is superior to fasting plasma glucose as an independent risk factor for colorectal neoplasia.
        Cancer Causes Control. 2012; 23: 321-328
        • Qiu Y.
        • Fu X.
        • Zhang W.
        • et al.
        Prevalence and molecular characterisation of the sessile serrated adenoma in a subset of the Chinese population.
        J Clin Pathol. 2014; 67: 491-498
        • Kumbhari V.
        • Behary J.
        • Hui J.M.
        Prevalence of adenomas and sessile serrated adenomas in Chinese compared with Caucasians.
        J Gastroenterol Hepatol. 2013; 28: 608-612
        • Zorzi M.
        • Fedeli U.
        • Schievano E.
        • et al.
        Impact on colorectal cancer mortality of screening programmes based on the faecal immunochemical test.
        Gut. 2015; 64: 784-790
        • Rozen P.
        • Levi Z.
        • Hazazi R.
        • et al.
        Identification of colorectal adenomas by a quantitative immunochemical faecal occult blood screening test depends on adenoma characteristics, development threshold used and number of tests performed.
        Aliment Pharmacol Ther. 2009; 29: 906-917