Evaluation of new occult blood tests for detection of colorectal neoplasia

D. James B.St. John, Graeme P. Young, Masha A. Alexeyeff, Melissa C. Deacon, Alan M. Cuthbertson, Finlay A. Macrae, J. Campbell B. Penfold

Research output: Contribution to journalArticlepeer-review

151 Citations (Scopus)


Background: Hemoccult II, the guaiac-based fecal occult blood test used in most colorectal cancer screening programs, has an unsatisfactory sensitivity for asymptomatic colorectal neoplasms. We evaluated the relative performance of four fecal occult blood tests, directed against various components of the hemoglobin molecule. Methods: All tests, Hemoccult II, HemoccultSENSA (a more sensitive guaiac test), HemeSelect (an immunochemical test specific for human hemoglobin), and HemoQuant (the heme-porphyrin assay), were performed by 107 patients with symptomatic colorectal cancer and 81 patients with predominantly asymptomatic adenoma. Hemoccult-SENSA and HemeSelect were performed by 1,355 screenees. Results: HemeSelect and HemoccultSENSA had significantly higher sensitivity for colorectal cancer (97% and 94%, respectively) than the other tests. HemeSelect had the highest sensitivity for adenomas; in 45 patients with large (≥10 mm) adenomas, sensitivity was 76% for HemeSelect, 60% for HemoccultSENSA, and 42% for both Hemoccult and HemoQuant. In the screenees, estimated specificity was 97.8% for HemeSelect and 96.1% for HemoccultSENSA. Conclusions: HemeSelect and HemoccultSENSA have the highest levels of sensitivity for detection of colorectal neoplasia, but the immunochemical test HemeSelect provides the best combination of specificity and sensitivity.

Original languageEnglish
Pages (from-to)1661-1668
Number of pages8
Issue number6
Publication statusPublished - Jun 1993
Externally publishedYes


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