Diagnostic Performance of Fecal pks+ Escherichia coli for Detecting Neoplastic Colorectal Lesions in Suspected Colorectal Cancer Patients

Anton Sumarpo (Department of Clinical Pathology, Faculty of Medicine, Maranatha Christian University)
Ida Parwati (Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran – Hasan Sadikin Hospital, Bandung, Indonesia)
Fajar Wasilah (Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran – Hasan Sadikin Hospital, Bandung, Indonesia)
Didik Setyo Heriyanto (Department of Anatomical Pathology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada – Sardjito Hospital, Yogyakarta, Indonesia)

Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML)
Vol. 32 No. 3 (2026)

Genotoxin-producing pks+ Escherichia coli is implicated in the pathogenesis of colorectal cancer (CRC). This study was designed to evaluate the diagnostic performance of fecal pks+ E. coli as a non-invasive biomarker for CRC screening. In this cross-sectional study, fecal samples from 70 patients with suspected CRC were analyzed by quantitative polymerase chain reaction (qPCR) to detect the presence of pks+ E. coli. The diagnostic accuracy was assessed against colonoscopy and histopathology findings. Against histopathology as the gold standard, fecal pks+ E. coli detected neoplastic lesions with a sensitivity of 70.59% and a specificity of 65.22%. Notably, the relative gene copy number of pks+ E. coli was significantly higher in patients with neoplastic lesions compared to those with non-neoplastic findings. Fecal testing for pks+ E. coli demonstrates potential as a non-invasive biomarker for detecting neoplastic colorectal lesions, though further validations are needed.