On 2014 Apr 04, David Keller commented:

Move Leftward on MultiTarget's Receiver Operating Curve

The MultiTarget test has higher sensitivity but lower specificity than FIT, the standard colon cancer fecal screen (1). MultiTarget detects more colon malignancies but triggers more unnecessary colonoscopies. Colonoscopy is expensive and invasive, limiting the acceptability of false-positive fecal screens. MultiTarget’s Composite Score threshold was set at 183. Increasing this threshold score will increase specificity and lower sensitivity (2). It should be raised until MultiTarget’s specificity equals FIT’s; if, at that point, MultiTarget’s sensitivity remains higher than FIT’s, then replacing FIT screening with MultiTarget will detect more malignancies without forcing patients to undergo more unnecessary colonoscopies.

MultiTarget incorporates fecal hemoglobin testing. Reducing the cofactor X6 in the Logistic Score has the effect of increasing specificity and reducing sensitivity of the fecal hemoglobin component of MultiTarget without affecting the performance of the DNA components of the Composite Score.

Fecal hemoglobin testing should be eliminated from colon cancer stool screening protocols as DNA tests improve, because bleeding commonly originates from benign sources, such as hemorrhoids, degrading specificity.

References

1) Imperiale TF, Ransohoff DF, Itzkowitz SH, Levin TR, Lavin P, Lidgard GP, Ahlquist DA, Berger BM. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med. 2014 Apr 3;370(14):1287-97. doi: 10.1056/NEJMoa1311194. Epub 2014 Mar 19. PubMed PMID: 24645800.

2) Florkowski CM. Sensitivity, specificity, receiver-operating characteristic (ROC) curves and likelihood ratios: communicating the performance of diagnostic tests. Clin Biochem Rev. 2008 Aug;29 Suppl 1:S83-7. PubMed PMID: 18852864; PubMed Central PMCID: PMC2556590.

On 2014 Apr 04, David Keller commented:

Move Leftward on MultiTarget's Receiver Operating Curve

The MultiTarget test has higher sensitivity but lower specificity than FIT, the standard colon cancer fecal screen (1). MultiTarget detects more colon malignancies but triggers more unnecessary colonoscopies. Colonoscopy is expensive and invasive, limiting the acceptability of false-positive fecal screens. MultiTarget’s Composite Score threshold was set at 183. Increasing this threshold score will increase specificity and lower sensitivity (2). It should be raised until MultiTarget’s specificity equals FIT’s; if, at that point, MultiTarget’s sensitivity remains higher than FIT’s, then replacing FIT screening with MultiTarget will detect more malignancies without forcing patients to undergo more unnecessary colonoscopies.

MultiTarget incorporates fecal hemoglobin testing. Reducing the cofactor X6 in the Logistic Score has the effect of increasing specificity and reducing sensitivity of the fecal hemoglobin component of MultiTarget without affecting the performance of the DNA components of the Composite Score.

Fecal hemoglobin testing should be eliminated from colon cancer stool screening protocols as DNA tests improve, because bleeding commonly originates from benign sources, such as hemorrhoids, degrading specificity.

References

1) Imperiale TF, Ransohoff DF, Itzkowitz SH, Levin TR, Lavin P, Lidgard GP, Ahlquist DA, Berger BM. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med. 2014 Apr 3;370(14):1287-97. doi: 10.1056/NEJMoa1311194. Epub 2014 Mar 19. PubMed PMID: 24645800.

2) Florkowski CM. Sensitivity, specificity, receiver-operating characteristic (ROC) curves and likelihood ratios: communicating the performance of diagnostic tests. Clin Biochem Rev. 2008 Aug;29 Suppl 1:S83-7. PubMed PMID: 18852864; PubMed Central PMCID: PMC2556590.