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Canadian Journal of Gastroenterology
Volume 27 (2013), Issue 8, Pages 467-475

Diagnostic Value of Stool Dna Testing for Multiple Markers Of Colorectal Cancer and Advanced Adenoma: A Meta-Analysis

Hua Yang,1,2 Bing-Qing Xia,1,2 Bo Jiang,1,2 Guozhen Wang,1,2 Yi-Peng Yang,1,2 Hao Chen,1,2 Bing-Sheng Li,3 An-Gao Xu,4 Yun-Bo Huang,1,2 and Xin-Ying Wang1,2

1Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
2Guangdong Provincial Key Laboratory of Gastroenterology, Huizhou, Guangdong, China
3Huizhou First Hospital, Huizhou, Guangdong, China
4Huizhou Medical Institute, Huizhou, Guangdong, China

Received 12 November 2012; Accepted 6 May 2013

Copyright © 2013 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND AND OBJECTIVES: The diagnostic value of stool DNA (sDNA) testing for colorectal neoplasms remains controversial. To compensate for the lack of large-scale unbiased population studies, a meta-analysis was performed to evaluate the diagnostic value of sDNA testing for multiple markers of colorectal cancer (CRC) and advanced adenoma.

METHODS: The PubMed, Science Direct, Biosis Review, Cochrane Library and Embase databases were systematically searched in January 2012 without time restriction. Meta-analysis was performed using a random-effects model using sensitivity, specificity, diagnostic OR (DOR), summary ROC curves, area under the curve (AUC), and 95% CIs as effect measures. Heterogeneity was measured using the χ2 test and Q statistic; subgroup analysis was also conducted.

RESULTS: A total of 20 studies comprising 5876 individuals were eligible. There was no heterogeneity for CRC, but adenoma and advanced adenoma harboured considerable heterogeneity influenced by risk classification and various detection markers. Stratification analysis according to risk classification showed that multiple markers had a high DOR for the high-risk subgroups of both CRC (sensitivity 0.759 [95% CI 0.711 to 0.804]; specificity 0.883 [95% CI 0.846 to 0.913]; AUC 0.906) and advanced adenoma (sensitivity 0.683 [95% CI 0.584 to 0.771]; specificity 0.918 [95% CI 0.866 to 0.954]; AUC 0.946) but not for the average-risk subgroups of either. In the methylation subgroup, sDNA testing had significantly higher DOR for CRC (sensitivity 0.753 [95% CI 0.685 to 0.812]; specificity 0.913 [95% CI 0.860 to 0.950]; AUC 0.918) and advanced adenoma (sensitivity 0.623 [95% CI 0.527 to 0.712]; specificity 0.926 [95% CI 0.882 to 0.958]; AUC 0.910) compared with the mutation subgroup. There was no significant heterogeneity among studies for subgroup analysis.

CONCLUSION: sDNA testing for multiple markers had strong diagnostic significance for CRC and advanced adenoma in high-risk subjects. Methylation makers had more diagnostic value than mutation markers.