[Analysis of the statistical value of various commercially available stool tests - a comparison of one stool sample in correlation to colonoscopy]. / Evaluierung der statistischen Kennwerte verschiedener kommerziell erhältlicher Stuhltests - Ein Quervergleich aus derselben Stuhlprobe in Korrelation zur Koloskopie.

INTRODUCTION: Guajac based fecal occult blood tests have proven to reduce mortality of colorectal cancer - despite their unsatisfactory statistical values. The potential of newer tests is yet inconclusive. We compared two guajac based, four immunochemical and the M2-PK test with colonoscopic and histological results as a reference. METHODS: In 1128 stool samples of patients undergoing (screening) colonoscopy the mentioned tests were performed. RESULTS: Positivity rate was 1.9 to 4.1 % for guajac based and immunochemical tests, M2-PK reached 11.6 %. In case of advanced neoplasias, no significant differences in sensitivity (7.3 - 20 %), specifity (96.6 - 98.4 %), positive predictive value (16.7 - 30.6 %) or accuracy (92.9 - 94.0 %) between guajac based and immunochemical tests were encountered. The slightly higher sensitivity of M2-PK (27.3 %) did not reach statistical significance - however the comparatively low specifity (89.2 %) and accuracy (86.2 %) were clearly lower compared to all other tests. Regarding all neoplasia, immunochemical tests performed better than conventional hemoccult, but the difference did not reach statistical significance. In this group, the sensitivity of M2-PK is clearly better, but specifity is clearly inferior to all other tests. DISCUSSION: Low sensitivity and low predictive values are explained by the study design with single test and low prevalence of neoplasia. Due to small numbers, there is only a trend, but no significant difference between the performance of conventional hemoccult compared with immunochemical and high senstitive guajac tests. Because of its low specificity, M2-PK is not an appropriate screening test for colorectal neoplasia.

[Results of coloscopy screening in 2005--an Internet-based documentation]. / Ergebnisse der Vorsorge-Koloskopie 2005--Internet-basierte Dokumentation.

BACKGROUND AND OBJECTIVE: In October 2002 screening coloscopy was introduced into the National Cancer Prevention Programme in Germany. The results of an online registry are presented here. METHODS: Data from consecutive screening colonoscopies in the practices of the 280 participating gastroenterologists, performed in asymptomatic subjects, were collected in an online registry. Number and histology of colorectal polyps and carcinomas, complication rates of colonoscopy and polypectomy were registered. Advanced adenoma was defined as an adenoma >10 mm in diameter, with villous or tubulovillous histology, or presence of high-grade dysplasia. RESULTS: A total of 109989 colonoscopies (43% in males) were evaluated from October 2003 to July 2005. Tubular and villous adenomas were found in 16.2% and 3.8%, respectively, whereas invasive cancers were diagnosed in 0.7%. Advanced adenomas amounted to 6.1%.The majority of carcinomas were detected in early stages (UICC stages I and II in 48 and 22 %, respectively). -In most of the polyps immediate polypectomy was carried out. The complication rate was low and no deaths were observed: cardiopulmonary complications occurred in 0.10% of the colonoscopies, bleeding in 0.79% of polypectomies most of which were managed endoscopically (surgery in 0.04% of polypectomies). Perforation occurred in 0.02% of the colonoscopies and 0.10% of polypectomies. CONCLUSIONS: Neoplasias of the colon were detected in about 20% of persons who had taken part in a colonoscopy screening programme: most of the lesions were immediately removed by polypectomy. The high rate of early stages of colorectal cancers detected by screening colonoscopy is an indirect indicator of mortality reduction. In Germany screening colonoscopy has a low risk.

[Ultrasonically guided fine-needle puncture. The limits of the method in the abdomen and retroperitoneal space]. / Ultraschallgesteuerte Feinnadelpunktion. Grenzen der Methode im Abdomen und Retroperitonealraum.

The sensitivity and specificity of ultrasound-directed fine-needle biopsy in the differentiation of malignancy or otherwise of structures in the abdomen or retroperitoneal space which look suspicious on ultrasound was evaluated from results in 558 patients (306 men, 252 women). Data from two different centres were used to characterize further the influence of different techniques of puncture, cytopathologists and groups of patients on the validity of the examination. Sensitivity (in the two centres) was 88 and 80%, respectively, specificity 100 and 99%. The validity of the examination was the same at both centres. In both centres the sensitivity was worst for pancreatic tissue, at only 72 and 61% respectively, compared with other organs (e.g. liver, lymph nodes, kidney) (P less than 0.05). Fine-needle biopsy of abdominal and retroperitoneal organs will thus be subject to a not insignificant number of false-negative results of cytological examination.