Comparative Diagnostic Accuracy of Fecal Occult Blood Test and Fecal Matrix Metalloproteinase-9 for Noninvasive Detection of Colorectal Cancer: A Cross-Sectional Study

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Introduction: Colorectal cancer (CRC) ranks as the third most common malignancy and the second leading cause of cancer-related mortality globally. Early detection is vital to improving outcomes. The fecal occult blood test (FOBT) is widely used as a noninvasive screening tool but has limited diagnostic precision. Fecal matrix metalloproteinase-9 (MMP-9) has emerged as a promising biomarker, with limited regional validation in Southeast Asia. This study compared the diagnostic performance of FOBT and fecal MMP-9 against colonoscopy in detecting CRC. Materials and Methods: A cross-sectional diagnostic accuracy study was conducted from July to September 2024 among 90 patients undergoing colonoscopy at Wahidin Sudirohusodo Hospital, Indonesia. All participants provided stool samples for FOBT and fecal MMP-9 quantification via enzyme-linked immunosorbent assay (ELISA). Colonoscopy with histopathology served as the reference standard. Sensitivity, specificity, predictive values, area under the ROC curve (AUC), Youden’s index, and 95% confidence intervals (CIs) were calculated. Results: The mean participant age was 50.9 ± 15.6 years, with 51.1 % male. CRC was diagnosed in 37.8 % of cases. FOBT showed high sensitivity but low specificity (97.1 %, 95% CI 85.1–99.9; 32.7 %, 95% CI 20.6–46.7; AUC = 0.646 [95% CI 0.534–0.758]; Youden = 0.298). Fecal MMP-9, using an empirically derived ROC cut-off 0.153 ng/mL, yielded balanced performance (sensitivity 76.5 %, 95% CI 58.8–89.3; specificity 76.8 %, 95% CI 63.6–87.0; AUC = 0.835 [95% CI 0.751–0.918]; Youden = 0.533). Conclusion: Fecal MMP-9 demonstrated greater overall accuracy compared with FOBT and may serve as a promising noninvasive biomarker to enhance colorectal cancer screening efficiency, particularly in resource-limited settings.

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