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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2015; 21(14): 4111-4120
Published online Apr 14, 2015. doi: 10.3748/wjg.v21.i14.4111
Point-of-care testing in the diagnosis of gastrointestinal cancers: Current technology and future directions
Jeremy R Huddy, Melody Z Ni, Sheraz R Markar, George B Hanna
Jeremy R Huddy, Melody Z Ni, Sheraz R Markar, George B Hanna, Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, South Wharf Road, W2 1NY London, United Kingdom
Author contributions: Hanna GB conceptualized the paper; Huddy JR conducted the literature search; all authors were involved in the manuscript development and its revision; all authors read and approved the final manuscript.
Supported by NIHR Diagnostic Evidence Co-operative London at Imperial College Healthcare NHS Trust is funded by the National Institute for Health Research.
Conflict-of-interest: The authors declare no conflicts-of-interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: George B Hanna, PhD, FRCS, Professor, Head, Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, Academic Surgical Unit, 10th Floor, QEQM Building, South Wharf Road, W2 1NY London, United Kingdom. g.hanna@imperial.ac.uk
Telephone: +44-207-8862124 Fax: +44-207-8866309
Received: December 17, 2014
Peer-review started: December 18, 2014
First decision: January 8, 2015
Revised: January 20, 2015
Accepted: February 13, 2015
Article in press: February 13, 2015
Published online: April 14, 2015
Processing time: 118 Days and 13.6 Hours
Abstract

Point-of-care (POC) tests enable rapid results and are well established in medical practice. Recent advances in analytical techniques have led to a new generation of POC devices that will alter gastrointestinal diagnostic pathways. This review aims to identify current and new technologies for the POC diagnosis of gastrointestinal cancer. A structured search of the Embase and Medline databases was performed. Papers reporting diagnostic tests for gastrointestinal cancer available as a POC device or containing a description of feasibility for POC application were included. Studies recovered were heterogeneous and therefore results are presented as a narrative review. Six diagnostic methods were identified (fecal occult blood, fecal proteins, volatile organic compounds, pyruvate kinase isoenzyme type M2, tumour markers and DNA analysis). Fecal occult blood testing has a reported sensitivity of 66%-85% and specificity greater than 95%. The others are at a range of development and clinical application. POC devices have a proven role in the diagnosis of gastrointestinal cancer. Barriers to their implementation exist and the transition from experimental to clinical medicine is currently slow. New technologies demonstrate potential to provide accurate POC tests and an ability to diagnose gastrointestinal cancer at an early stage with improved clinical outcome and survival.

Keywords: Colorectal cancer; Cancer-diagnosis; Gastric cancer; Esophageal cancer; Diagnostic tests

Core tip: Point-of-care tests are well established. They facilitate real time clinical decision-making and can be cost-effective, reduce in-patient hospital stay and increase patient satisfaction. Faecal Occult Blood has been used internationally since 1993 in screening for colorectal cancer. Six technologies for current or potential point-of-care diagnosis of gastro-intestinal cancer were identified from the literature (faecal occult blood, faecal proteins, volatile organic compounds, pyruvate kinase isoenzyme type M2, tumour markers and DNA analysis). Currently, three have commercially available point-of-care devices. New technologies demonstrate potential to provide accuracy and an ability to diagnose gastrointestinal cancer earlier leading to improved clinical outcome and survival.