Background and study aims Colorectal cancer (CRC) is a common neoplasm in Western countries. Prioritizing access to colonoscopy appears of critical relevance. Alarm features are considered to increase the likelihood of CRC. Aim was to assess the diagnostic performance of alarm features for CRC diagnosis. Patients and methods Systematic review and meta-analysis including studies reporting the diagnostic accuracy of alarm features (i.e., rectal bleeding, anemia, change in bowel habit, and weight loss) for CRC, published up to September 2021. Colonoscopy as reference diagnostic test was required. Diagnostic accuracy measures were pooled by a bivariate mixed-effects regression model. The number needed to scope (NNS), i.e. the number of patients who need to undergo colonoscopy to diagnose one CRC, according to each alarm feature was computed. Results Overall, 31 studies with 45,100 patients (mean age 31-88 years; male gender 36-63%) were included. Prevalence of CRC ranged from 0.2% to 22%. Sensitivity was suboptimal, i.e. ranging from 12.4% for weight loss to 49% for rectal bleeding, whereas specificity ranged from 69.8% for rectal bleeding to 91.9% for weight loss. Rectal bleeding and anemia as individually taken would be the only practical alarm features mandating colonoscopy, yielding NNS of 5.3 and 6.7 respectively. Conclusions When considered independently, alarm features have variable accuracy for CRC, given the high heterogeneity of study populations reflected by wide variability in CRC prevalence. Rectal bleeding and anemia are the most practical to select patients for colonoscopy. Integration of alarm features in a comprehensive evaluation of patient should be considered.
Clinical value of alarm features for colorectal cancer. A Meta-Analysis
Facciorusso, Antonio;
2022-01-01
Abstract
Background and study aims Colorectal cancer (CRC) is a common neoplasm in Western countries. Prioritizing access to colonoscopy appears of critical relevance. Alarm features are considered to increase the likelihood of CRC. Aim was to assess the diagnostic performance of alarm features for CRC diagnosis. Patients and methods Systematic review and meta-analysis including studies reporting the diagnostic accuracy of alarm features (i.e., rectal bleeding, anemia, change in bowel habit, and weight loss) for CRC, published up to September 2021. Colonoscopy as reference diagnostic test was required. Diagnostic accuracy measures were pooled by a bivariate mixed-effects regression model. The number needed to scope (NNS), i.e. the number of patients who need to undergo colonoscopy to diagnose one CRC, according to each alarm feature was computed. Results Overall, 31 studies with 45,100 patients (mean age 31-88 years; male gender 36-63%) were included. Prevalence of CRC ranged from 0.2% to 22%. Sensitivity was suboptimal, i.e. ranging from 12.4% for weight loss to 49% for rectal bleeding, whereas specificity ranged from 69.8% for rectal bleeding to 91.9% for weight loss. Rectal bleeding and anemia as individually taken would be the only practical alarm features mandating colonoscopy, yielding NNS of 5.3 and 6.7 respectively. Conclusions When considered independently, alarm features have variable accuracy for CRC, given the high heterogeneity of study populations reflected by wide variability in CRC prevalence. Rectal bleeding and anemia are the most practical to select patients for colonoscopy. Integration of alarm features in a comprehensive evaluation of patient should be considered.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
