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Endoscopy 2023; 55(05): 458-468
DOI: 10.1055/a-1961-4266
Systematic review

Clinical value of alarm features for colorectal cancer: a meta-analysis

Leonardo Frazzoni 
1   Department of Digestive Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
,
Liboria Laterza
1   Department of Digestive Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
,
Marina La Marca
2   Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Bologna, Italy
,
Rocco Maurizio Zagari 
1   Department of Digestive Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
2   Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Bologna, Italy
,
Franco Radaelli
3   Gastroenterology Unit, Valduce Hospital, Como, Italy
,
Cesare Hassan
4   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
5   Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
,
Alessandro Repici
4   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
5   Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
,
Antonio Facciorusso 
6   Department of Medical and Surgical Sciences, Section of Gastroenterology, University of Foggia, Foggia, Italy
,
Paraskevas Gkolfakis
7   Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
,
Cristiano Spada
8   Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
,
Konstantinos Triantafyllou 
9   Hepatogastroenterology Unit, 2nd Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
,
Franco Bazzoli
2   Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Bologna, Italy
,
Mario Dinis-Ribeiro   *
10   Porto Comprehensive Cancer Center (Porto.CCC), Porto, Portugal
11   RISE@CI-IPOP (Health Research Network), Porto, Portugal
,
Lorenzo Fuccio    *
1   Department of Digestive Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
2   Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Bologna, Italy
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Abstract

Background Colorectal cancer (CRC) is a common neoplasm in Western countries. Prioritizing access to colonoscopy appears of critical relevance. Alarm features are considered to increase the likelihood of CRC. Our aim was to assess the diagnostic performance of alarm features for CRC diagnosis.

Methods We performed a systematic review and meta-analysis of studies reporting the diagnostic accuracy of alarm features (rectal bleeding, anemia, change in bowel habit, and weight loss) for CRC, published up to September 2021. Colonoscopy was required as the reference diagnostic test. Diagnostic accuracy measures were pooled by a bivariate mixed-effects regression model. The number needed to scope (NNS; i. e. the number of patients who need to undergo colonoscopy to diagnose one CRC) according to each alarm feature was calculated.

Results 31 studies with 45 100 patients (mean age 31–88 years; men 36 %–63 %) were included. The prevalence of CRC ranged from 0.2 % to 22 %. Sensitivity was suboptimal, ranging from 12.4 % for weight loss to 49 % for rectal bleeding, whereas specificity ranged from 69.8 % for rectal bleeding to 91.9 % for weight loss. Taken individually, rectal bleeding and anemia would be the only practical alarm features mandating colonoscopy (NNS 5.3 and 6.7, respectively).

Conclusions When considered independently, alarm features have variable accuracy for CRC, given the high heterogeneity of study populations reflected by wide variability in CRC prevalence. Rectal bleeding and anemia are the most practical to select patients for colonoscopy. Integration of alarm features in a comprehensive evaluation of patients should be considered.

* Joint last authors.


Supplementary material



Publication History

Received: 01 March 2022

Accepted after revision: 14 October 2022

Accepted Manuscript online:
14 October 2022

Article published online:
11 January 2023

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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