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Trial summary: Experience with community-based FiT screening in albertaCrouse AL, De Koning L, Sadrzadeh SmH, Naugler C. Sensitivity and specificity of community fecal immunohistochemical testing (FIT) screening for colorectal carcinoma in Calgary, Alberta. Canadian Association of Pathologists Annual meeting, Abstract P144.

Community-based programs are an ideal way to promote colorectal cancer screening by primary care physicians. Fecal immunohistochemical testing (FIT) is a screening method used in these types of programs as it presents advantages to the patient as well as to clinical laboratories. In this paper, the authors assessed the operational test char-acteristics of a FIT pilot program in Calgary, Alberta.

A total of 457 patients underwent FIT testing and had corresponding biopsy results that were classified as carcinoma, advanced polyp and low-grade polyp. Receiver operator characteristic (ROC) curves were constructed from these results. Subgroup analysis was also performed on males and females and for ages greater than and less than the mean age of 62. Areas under the curve (AUC) were derived from the maximum FIT and biopsy results.

Results: For carcinoma, advanced polyp and low-grade polyp the AUCs were 0.79 (95% Cl 0.71–0.87), 0.57 (95% Cl 0.50–0.64) and 0.49 (95% Cl 0.41–0.54) respectively. The authors find that FIT is a good predictor of colorectal carcinoma, but a poor predictor of advanced and tubular adenomas. Additionally, FIT was more predictive in women and younger individuals. The poor performance of FIT for adenomas suggests that it may miss early-stage lesions and therefore should not be considered equivalent to screening colonoscopy.

CommEnTary: Physicians are now living in an era of “big data,” which includes clinical information from elec-tronic records, laboratory tests, imaging, histomorphology, molecular biomarkers and genetic sequencing information.8 Navigating and appropriately interpreting the sea of big data can not only help with the immediate care of individual patients, but can also help hospitals predict future demand in lab testing, allow clinicians to target specific populations in the community for cancer screening, and tease out risk-disease associations that can be lost with conventional-scale trials.9 In this report, Crouse et al used population-based data to highlight some of the potential limitations of FIT.10,11 They found that FIT testing in the community was a good predictor for colorectal carcinoma but not for tubular ade-nomas. The authors illustrated how to mine big data sets in a laboratory information system (LIS). With faster comput-

IN BRIEFalready known• Fecal immunohistochemical testing (FIT) is used in

community-based screening programs for colorectal cancer. The test presents advantages for patients, primary care physicians and laboratories.

What this study showed• In 457 patients participating in a screening pilot

project in Calgary Alberta, FIT effectively predicted colorectal carcinoma but was a poor predictor of advanced and tubular adenomas. FIT also appears a better predictor in women and younger patients.

next steps• Appropriate use of “big data” generated from

electronic records, laboratory testing, imaging, and genetic sequencing can identify associations and tailor screening and treatments to targeted populations.

ing, new technology and the application of appropriate sta-tistical analysis methodology, big data can be used to arrive at clinically relevant conclusions. In future, individual centres will be able to direct therapy, screening and monitoring using data mined in their own LIS and tailored to the com-munity they serve.

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Colorectal cancerFeCAL ImmuNOHISTOCHemICAL TeSTINg FOr COLOreCTAL CANCer

Chelsea maedler, Bsc, mD, Anatomic Pathology resident, mcgill university; Zu-Hua Gao, mD, PhD, FrCP(C), Pathologist-in-Chief, mcgill university Health Centre

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