Yonsei Med J.  2017 Jan;58(1):150-157. 10.3349/ymj.2017.58.1.150.

Are Hemorrhoids Associated with False-Positive Fecal Immunochemical Test Results?

• Kim NH
• Park JH
• Park DI
• Sohn CI
• Choi K
• Jung YS

• KMID: 2374201
• DOI: http://doi.org/10.3349/ymj.2017.58.1.150

Abstract

PURPOSE
False-positive (FP) results of fecal immunochemical tests (FITs) conducted in colorectal cancer (CRC) screening could lead to performing unnecessary colonoscopies. Hemorrhoids are a possible cause of FP FIT results; however, studies on this topic are extremely rare. We investigated whether hemorrhoids are associated with FP FIT results.
MATERIALS AND METHODS
A retrospective study was conducted at a university hospital in Korea from June 2013 to May 2015. Of the 34547 individuals who underwent FITs, 3946 aged ≥50 years who underwent colonoscopies were analyzed. Logistic regression analysis was performed to determine factors associated with FP FIT results.
RESULTS
Among 3946 participants, 704 (17.8%) showed positive FIT results and 1303 (33.0%) had hemorrhoids. Of the 704 participants with positive FIT results, 165 had advanced colorectal neoplasia (ACRN) and 539 had no ACRN (FP results). Of the 1303 participants with hemorrhoids, 291 showed FP results, of whom 81 showed FP results because of hemorrhoids only. Participants with hemorrhoids had a higher rate of FP results than those without hemorrhoids (291/1176, 24.7% vs. 248/2361, 10.5%; p<0.001). Additionally, the participants with hemorrhoids as the only abnormality had a higher rate of FP results than those experiencing no such abnormalities (81/531, 15.3% vs. 38/1173, 3.2%; p<0.001). In multivariate analysis, the presence of hemorrhoids was identified as an independent predictor of FP results (adjusted odds ratio, 2.76; 95% confidence interval, 2.24-3.40; p<0.001).
CONCLUSION
Hemorrhoids are significantly associated with FP FIT results. Their presence seemed to be a non-negligible contributor of FP results in FIT-based CRC screening programs.

Keyword

Hemorrhoids; false-positive; fecal immunochemical test

MeSH Terms

Aged
Colonoscopy
Colorectal Neoplasms/*diagnosis
Confidence Intervals
Early Detection of Cancer/methods
False Positive Reactions
Female
*Hemorrhoids
Humans
Male
Middle Aged
Multivariate Analysis
*Occult Blood
Odds Ratio
Regression Analysis
Republic of Korea
Retrospective Studies
Unnecessary Procedures

Figure

• 

  Fig. 1 Flow diagram illustrating the selection of study subjects. FIT, fecal immunochemical test; F-Hb, fecal hemoglobin; CRC, colorectal cancer.

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  Fig. 2 (A) External hemorrhoid. (B) Internal hemorrhoid.

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