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

Agus Hariyanto; Warsinggih Warsinggih; Muhammad Luthfi Parewangi; M. Ihwan Kusuma; Samuel Sampetoding; Julianus Aboyaman Uwuratuw; Muhammad Faruk

doi:10.31557/apjcc.2026.11.1.97-105

Authors

Agus Hariyanto Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
Warsinggih Warsinggih Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Hasanuddin University Hospital, Makassar, Indonesia. https://orcid.org/0000-0002-1756-9039
Muhammad Luthfi Parewangi Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. https://orcid.org/0000-0001-9257-9344
M. Ihwan Kusuma Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. http://orcid.org/0000-0002-5414-1859
Samuel Sampetoding Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. https://orcid.org/0000-0003-2690-0843
Julianus Aboyaman Uwuratuw Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. https://orcid.org/0000-0002-7116-6628
Muhammad Faruk Hasanuddin University Hospital, Makassar, Indonesia. Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. https://orcid.org/0000-0002-7079-4585

DOI:

https://doi.org/10.31557/apjcc.2026.11.1.97-105

Keywords:

colorectal cancer, fecal occult blood test, matrix metalloproteinase-9, biomarker, diagnostic accuracy, screening

Abstract

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.