Stage-Specific Sensitivity of Fecal Immunochemical Tests for Detecting Colorectal Cancer: Systematic Review and Meta-Analysis.

"CONFLICTS OF INTEREST Guarantor of the article: Tobias Niedermaier, MPH, PhD. The lead author affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. Specific author contributions: H.B. designed the study. T.N. and Y.B. conducted the literature search and extracted the data. T.N. conducted the statistical analyses and drafted the manuscript. H.B. and Y.B. contributed important intellectual content and critically revised the manuscript. Financial support: No specific funding was obtained for this study. Potential competing interests: None to report. Study HighlightsWHAT IS KNOWN✓ Overall, FITs detect the majority of CRCs in a single screening round. Cure rates for CRC are highest when detected at an early stage, making it valuable to derive stage-specific estimates of characteristics of FITs for CRC detection.✓ Although FITs are suggested to detect larger proportions of late-stage CRCs compared with early-stage CRCs due to stronger bleeding, these potential differences have not yet been systematically investigated and quantified.WHAT IS NEW HERE✓ We reviewed and summarized evidence on the stage-specific sensitivity of FITs for CRC detection.✓ Forty-four studies comprising a total of ∼92,500 participants and ∼3,000 CRC cases were included, yielding stage-specific estimates of FIT accuracy with high precision.✓ Pooled sensitivities (95% CIs) of FIT were 73% (65%–79%) for stage-I-CRCs and 80% (74%–84%), 82% (77%–87%), and 79% (70%–86%) for stages II, III, and IV, respectively. Sensitivity was particularly low for T1 CRCs (40%, 95% CI 21%–64%).✓ These results will enable estimating expected effectiveness and cost-effectiveness of planned screening programs with enhanced accuracy. A comparably low sensitivity of FIT for stage-I-CRCs and for T1 CRCs in particular warrants further research on ways to improve FITs in the detection of early-stage CRC."

"Financial support: No specific funding was obtained for this study."