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AIM:To determine the role of the fecal immunochemical test(FIT),used to evaluate fecal hemoglobin concentration,in the prediction of histological grade and risk of colorectal tumors.METHODS:We enrolled 17881 individuals who attended the two-step colorectal cancer screening program in a single hospital between January 2010 and October 2011.Colonoscopy was recommended to the participants with an FIT of≥12 ngHb/mL buffer.We classified colorectal lesions as cancer(C),advanced adenoma(AA),adenoma(A),and others(O)by their colonoscopic and histological findings.Multiple linear regression analysis adjusted for age and gender was used to determine the association between the FIT results and colorectal tumor grade.The risk of adenomatous neoplasia was estimated by calculating the positive predictive values for different FIT concentrations.RESULTS:The positive rate of the FIT was 10.9%(1948/17881).The attendance rate for colonoscopy was 63.1%(1229/1948).The number of false positive results was 23.Of these 1229 cases,the numbers of O,A,AA,and C were 759,221,201,and 48,respectively.Regression analysis revealed a positive association between histological grade and FIT concentration(β=0.088,P<0.01).A significant log-linear relationship was found between the concentration and positive predictive value of the FIT for predicting colorectal tumors(R2>0.95,P<0.001).CONCLUSION:Higher FIT concentrations are associated with more advanced histological grades.Risk prediction for colorectal neoplasia based on individual FIT concentrations is significant and may help to improve the performance of screening programs.