The diagnostic accuracy of a single CEA blood test in detecting colorectal cancer recurrence: Results from the FACS trial.
<h4>Objective</h4> <p>To evaluate the diagnostic accuracy of a single CEA (carcinoembryonic antigen) blood test in detecting colorectal cancer recurrence.</p> <h4>Background</h4> <p>Patients who have undergone curative resection for primary colorectal cance...
| Main Authors: | , , , , , , |
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| Format: | Journal article |
| Language: | English |
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Public Library of Science
2017
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| _version_ | 1826258452441202688 |
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| author | Shinkins, B Nicholson, B Primrose, J Perera, R James, T Pugh, S Mant, D |
| author_facet | Shinkins, B Nicholson, B Primrose, J Perera, R James, T Pugh, S Mant, D |
| author_sort | Shinkins, B |
| collection | OXFORD |
| description | <h4>Objective</h4> <p>To evaluate the diagnostic accuracy of a single CEA (carcinoembryonic antigen) blood test in detecting colorectal cancer recurrence.</p> <h4>Background</h4> <p>Patients who have undergone curative resection for primary colorectal cancer are typically followed up with scheduled CEA testing for 5 years. Decisions to investigate further (usually by CT imaging) are based on single test results, reflecting international guidelines.</p> <h4>Methods</h4> <p>A secondary analysis was undertaken of data from the FACS trial (two arms included CEA testing). The composite reference standard applied included CT-CAP imaging, clinical assessment and colonoscopy. Accuracy in detecting recurrence was evaluated in terms of sensitivity, specificity, likelihood ratios, predictive values, time-dependent area under the ROC curves, and operational performance when used prospectively in clinical practice are reported.</p> <h4>Results</h4> <p>Of 582 patients, 104 (17.9%) developed recurrence during the 5 year follow-up period. Applying the recommended threshold of 5μg/L achieves at best 50.0% sensitivity (95% CI: 40.1±59.9%); in prospective use in clinical practice it would lead to 56 missed recurrences (53.8%; 95% CI: 44.2±64.4%) and 89 false alarms (56.7% of 157 patients referred for investigation). Applying a lower threshold of 2.5μg/L would reduce the number of missed recurrences to 36.5% (95% CI: 26.5±46.5%) but would increase the false alarms to 84.2% (924/ 1097 referred). Some patients are more prone to false alarms than othersÐat the 5μg/L threshold, the 89 episodes of unnecessary investigation were clustered in 29 individuals.</p> <h4>Conclusion</h4> <p>Our results demonstrated very low sensitivity for CEA, bringing to question whether it could ever be used as an independent triage test. It is not feasible to improve the diagnostic performance of a single test result by reducing the recommended action threshold because of the workload and false alarms generated. Current national and international guidelines merit reevaluation and options to improve performance, such as making clinical decisions on the basis of CEA trend, should be further assessed.</p> |
| first_indexed | 2024-03-06T18:34:13Z |
| format | Journal article |
| id | oxford-uuid:0aae0a94-d6ee-41be-9afe-a9e80ec61b04 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T18:34:13Z |
| publishDate | 2017 |
| publisher | Public Library of Science |
| record_format | dspace |
| spelling | oxford-uuid:0aae0a94-d6ee-41be-9afe-a9e80ec61b042022-03-26T09:25:09ZThe diagnostic accuracy of a single CEA blood test in detecting colorectal cancer recurrence: Results from the FACS trial.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:0aae0a94-d6ee-41be-9afe-a9e80ec61b04EnglishSymplectic Elements at OxfordPublic Library of Science2017Shinkins, BNicholson, BPrimrose, JPerera, RJames, TPugh, SMant, D <h4>Objective</h4> <p>To evaluate the diagnostic accuracy of a single CEA (carcinoembryonic antigen) blood test in detecting colorectal cancer recurrence.</p> <h4>Background</h4> <p>Patients who have undergone curative resection for primary colorectal cancer are typically followed up with scheduled CEA testing for 5 years. Decisions to investigate further (usually by CT imaging) are based on single test results, reflecting international guidelines.</p> <h4>Methods</h4> <p>A secondary analysis was undertaken of data from the FACS trial (two arms included CEA testing). The composite reference standard applied included CT-CAP imaging, clinical assessment and colonoscopy. Accuracy in detecting recurrence was evaluated in terms of sensitivity, specificity, likelihood ratios, predictive values, time-dependent area under the ROC curves, and operational performance when used prospectively in clinical practice are reported.</p> <h4>Results</h4> <p>Of 582 patients, 104 (17.9%) developed recurrence during the 5 year follow-up period. Applying the recommended threshold of 5μg/L achieves at best 50.0% sensitivity (95% CI: 40.1±59.9%); in prospective use in clinical practice it would lead to 56 missed recurrences (53.8%; 95% CI: 44.2±64.4%) and 89 false alarms (56.7% of 157 patients referred for investigation). Applying a lower threshold of 2.5μg/L would reduce the number of missed recurrences to 36.5% (95% CI: 26.5±46.5%) but would increase the false alarms to 84.2% (924/ 1097 referred). Some patients are more prone to false alarms than othersÐat the 5μg/L threshold, the 89 episodes of unnecessary investigation were clustered in 29 individuals.</p> <h4>Conclusion</h4> <p>Our results demonstrated very low sensitivity for CEA, bringing to question whether it could ever be used as an independent triage test. It is not feasible to improve the diagnostic performance of a single test result by reducing the recommended action threshold because of the workload and false alarms generated. Current national and international guidelines merit reevaluation and options to improve performance, such as making clinical decisions on the basis of CEA trend, should be further assessed.</p> |
| spellingShingle | Shinkins, B Nicholson, B Primrose, J Perera, R James, T Pugh, S Mant, D The diagnostic accuracy of a single CEA blood test in detecting colorectal cancer recurrence: Results from the FACS trial. |
| title | The diagnostic accuracy of a single CEA blood test in detecting colorectal cancer recurrence: Results from the FACS trial. |
| title_full | The diagnostic accuracy of a single CEA blood test in detecting colorectal cancer recurrence: Results from the FACS trial. |
| title_fullStr | The diagnostic accuracy of a single CEA blood test in detecting colorectal cancer recurrence: Results from the FACS trial. |
| title_full_unstemmed | The diagnostic accuracy of a single CEA blood test in detecting colorectal cancer recurrence: Results from the FACS trial. |
| title_short | The diagnostic accuracy of a single CEA blood test in detecting colorectal cancer recurrence: Results from the FACS trial. |
| title_sort | diagnostic accuracy of a single cea blood test in detecting colorectal cancer recurrence results from the facs trial |
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