Immunologische Stuhlbluttests zur Darmkrebsfrüherkennung

 

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Zusammenfassung

Zur Früherkennung von Darmkrebs bieten fäkale immunologische Tests auf Hämoglobin (FITs) im Vergleich zu Guajak-basierten Stuhlbluttests viele Vorteile, u. a. hinsichtlich diagnostischer Wertigkeit und Teilnahmeraten. Auf dem Markt sind unterschiedliche FITs verfügbar, nämlich qualitative FITs in Form von Schnelltests und quantitative FITs. Obwohl die europäischen Leitlinien nur die Verwendung von quantitativen FITs empfehlen, gibt es immer wieder Bestrebungen, dies in Frage zu stellen und auch qualitative FITs als Option zuzulassen. In diesem Kommentar wird erläutert, welche Probleme sich bei qualitativen FITs hinsichtlich der Qualitätssicherung ergeben, insbesondere was die dauerhafte Kontrolle des Schwellenwertes betrifft. Des Weiteren wird aufgezeigt, dass diverse Argumente zugunsten qualitativer FITs einer kritischen und rationalen Prüfung nicht standhalten können. Insofern erscheint der Einsatz qualitativer FITs im Rahmen eines qualitätsgesicherten Früherkennungsprogramms nicht vertretbar.

Abstract

Fecal immunochemical tests for hemoglobin (FIT) offer several advantages over guaiac-based fecal occult blood testing in colorectal cancer screening, e. g. regarding diagnostic accuracy and participation rates. There are different FITs on the market, namely qualitative FITs (point-of-care tests) and quantitative FITs. Although the European Guidelines for quality assurance in colorectal cancer screening only recommend quantitative FITs, there are continued endeavors to question this and to also allow qualitative FITs as an option. In this commentary, we explain the problems that qualitative FITs pose in terms of quality assurance, particularly regarding the sustained control of the positivity threshold. We further show that various arguments raised in favor of qualitative FITs do not stand up to a critical and rational examination. The use of qualitative FITs is thus not a tenable option for a quality-assured screening program.

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