OBJECTIVE: Fecal immunochemical tests (FITs) detect the majority of colorectal cancers (CRCs), but evidence for variation in sensitivity according to the CRC stage is sparse and has not yet been systematically synthesized. Thus, our objective was to systematically review and summarize evidence on the stage-specific sensitivity of FITs. METHODS: We screened PubMed, Web of Science, Embase, and the Cochrane Library from inception to June 14, 2019, for English-language articles reporting on the stage-specific sensitivity of FIT for CRC detection using colonoscopy as a reference standard. Studies reporting stage-specific sensitivities and the specificity of FIT for CRC detection were included. Summary estimates of sensitivity according to the CRC stage and study setting (screening cohorts, symptomatic/diagnostic cohorts, and case-control studies) were derived from bivariate meta-analysis. RESULTS: Forty-four studies (92,447 participants including 3,034 CRC cases) were included. Pooled stage-specific sensitivities were overall very similar but suffered from high levels of imprecision because of small case numbers when calculated separately for screening cohorts, symptomatic/diagnostic cohorts, and case-control studies. Pooled sensitivities (95% confidence intervals) for all studies combined were 73% (65%–79%) for stage-I-CRCs and 80% (74%–84%), 82% (77%–87%), and 79% (70%–86%) for the detection of CRC stages II, III, and IV, respectively. Even substantially larger variation was seen in sensitivity by T-stage, with summary estimates ranging from 40% (21%–64%) for T1 to 83% (68%–91%) for T3-CRC. DISCUSSION: Although FITs detect 4 of 5 CRCs at stages II–IV, the substantially lower sensitivity for stage-I-CRC and, in particular, T1 CRC indicates both need and potential for further improvement in performance for the early detection of CRC.

中文翻译：

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粪便免疫化学检测检测结直肠癌的阶段特异性敏感性

目的：粪便免疫化学检测 (FIT) 可检测大多数结直肠癌 (CRC)，但根据 CRC 分期不同的敏感性变化的证据很少，尚未系统合成。因此，我们的目标是系统地回顾和总结关于 FIT 的阶段特异性敏感性的证据。方法：我们筛选了 PubMed、Web of Science、Embase 和 Cochrane 图书馆从成立到 2019 年 6 月 14 日的英文文章，以报告 FIT 对使用结肠镜检查作为参考标准检测 CRC 的特定阶段敏感性。包括报告阶段特异性敏感性和 FIT 对 CRC 检测的特异性的研究。根据 CRC 分期和研究环境（筛查队列、症状/诊断队列、和病例对照研究）来自双变量荟萃分析。结果：共纳入 44 项研究（92,447 名参与者，包括 3,034 名 CRC 病例）。汇总的特定阶段敏感性总体上非常相似，但由于在单独计算筛查队列、症状/诊断队列和病例对照研究时病例数较少，因此存在高度不精确性。所有研究的汇总敏感性（95% 置信区间）对于 I 期 CRC 为 73%（65%–79%），80%（74%–84%）、82%（77%–87%）和79% (70%–86%) 分别用于检测 CRC II、III 和 IV 期。T 阶段的敏感性甚至更大，总结估计范围从 T1 的 40% (21%–64%) 到 T3-CRC 的 83% (68%–91%)。讨论：尽管 FIT 在 II-IV 阶段检测到 5 个 CRC 中的 4 个，但