An urgent referral strategy for symptomatic patients with suspected colorectal cancer based on a quantitative immunochemical faecal occult blood test

Rodríguez‐Alonso, Lorena; Rodríguez-Moranta, Francisco; Ruíz-Cerulla, Alexandra; Lobatón, Triana; Aràjol, C; Binefa, Gemma; Moreno, Vı́ctor; Guardiola, Jordi

doi:10.1016/j.dld.2015.05.004

Cited by 53 publications

(101 citation statements)

References 29 publications

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“…Moreover, f-Hb increases as deprivation increases 13 14. One potential solution that takes these and other relevant variables into consideration in combination with the f-Hb concentration are risk-scoring models such as the very simple Score Card,15 the very complex COLONPREDICT model16 and the FAST score, which simply takes f-Hb, age and sex into account 17. However, their use in routine practice has yet to be evaluated in depth, but this sort of approach might simplify the interpretation of FIT results among GP considering making a referral to secondary care, particularly since the scores could be reported using the functionality available in most laboratory information systems, perhaps along with interpretative guidance.…”

Section: Introductionmentioning

confidence: 99%

Setting up a service for a faecal immunochemical test for haemoglobin (FIT): a review of considerations, challenges and constraints

2018

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Quantitative faecal immunochemical tests for haemoglobin (FIT) have now been advocated by the National Institute for Care and Health Excellence (NICE: DG30) to assist in the triage of patients presenting with symptoms that suggest a low risk of colorectal (bowel) cancer. The evidence is that FIT provides a good rule out test for significant bowel disease. However, a small number of cases will be missed, and robust safety-netting procedures are required to follow up some FIT-negative patients. A range of diagnostic pathways are possible, and there is no best approach at present. Introduction of FIT requires careful consideration of the logistics of supply of devices and information to requesting sites and of transport to the laboratory. A number of FIT analytical systems are available. Three are documented as appropriate for use in assessment of patients with symptoms. However, preanalytical, analytical and postanalytical challenges remain. The methods have different specimen collection devices. The methods use polyclonal antibodies and there is no primary reference material or method to which FIT methods are standardised. Third-party internal quality control is lacking, and external quality assessment schemes have many difficulties in providing appropriate materials. Reporting of results should be done using µg Hb/g faeces units and with knowledge of the limit of detection and limit of quantitation of the analytical system used. FIT can be used successfully in an agreed diagnostic pathway, along with other clinical and laboratory information: this requires a multidisciplinary approach, providing opportunities for professionals in laboratory medicine involvement.

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Section: Introductionmentioning

confidence: 99%

Setting up a service for a faecal immunochemical test for haemoglobin (FIT): a review of considerations, challenges and constraints

2018

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“…Finally, the data of 1002 patients were analyzed. As described in detail elsewhere [6], 133 patients were found to have AN (13.3%), including 103 patients with advanced adenoma (10.3%) and 30 patients with CRC (3.0%). Non-advanced adenoma was identified in 168 patients (16.8%).…”

Section: Resultsmentioning

confidence: 99%

“…This is a post hoc analysis of a previous study that evaluated an urgent referral strategy based on a quantitative FIT for symptomatic patients with suspected colorectal cancer (Rodriguez Alonso et a l, 2015) [6]. Briefly, the study included symptomatic patients of more than 18 years of age referred for diagnostic colonoscopy to the Endoscopy Unit of the Bellvitge University Hospital between September 2011 and October 2012, S1 File.…”

Section: Methodsmentioning

confidence: 99%

“…An exhaustive questionnaire was administered by a gastroenterologist in a face-to-face interview. In this consultation signs, symptoms, CRC risk factors and, use of medical drugs, including PPI intake and dose were recorded and a specimen collection device of FIT (OC Sensor ® , Eiken Chemical Co., Ltd., Tokyo, Japan) and the instructions on how to perform and storage the test at home were given [6]. Samples with collection or storage errors were excluded from the study.…”

Section: Methodsmentioning

confidence: 99%

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Proton pump inhibitors reduce the accuracy of faecal immunochemical test for detecting advanced colorectal neoplasia in symptomatic patients

et al. 2018

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BackgroundThe faecal immunochemical test (FIT) is used in colorectal cancer (CRC) screening and for the detection of advanced colorectal neoplasia (AN) in symptomatic patients, but its accuracy could be improved. Our objective was to assess the impact of proton pump inhibitors (PPI) on the accuracy of the FIT in the detection of AN, namely advanced colorectal adenoma and CRC.Methods and findingsWe performed a prospective study of 1002 individuals referred for a diagnostic colonoscopy at Bellvitge University Hospital from September 2011 through to October 2012. An exhaustive interview was performed by a gastroenterologist, prescription drug dispensing database was reviewed and the patient was given a FIT prior to colonoscopy. The positivity threshold of FIT used was ≥ 20 μg Hb/g feces and the main outcome was AN. AN was detected in 13.2% (133) of patients. The accuracy of FIT for detecting AN in the PPI users and non-PPI users were: sensitivity 43.0% vs 65.6%, P = 0.009; specificity 86.9% vs 92.3%, P = 0.010; and, predictive positive value 34.4% vs 55.5%, P = 0.007, respectively. In multivariate analysis, adjusting for potential confounders, PPIs were associated with false positives in AN detection by FIT (OR 1.63 CI 95% 1.02–2.59, P < 0.037). The ROC curve for the FIT in the detection of AN in the PPI users and non-PPI users was 0.68 (CI 95% 0.61–0.76) and 0.85 (CI 95% 0.79–0.90).ConclusionsPPI therapy reduces the accuracy of FIT for detecting AN in symptomatic patients.

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“…[12][13][14][15] This is discussed in detail by Fraser and Strachan in the accompanying Editorial. 16 The dilemma for many laboratories is whether to reimplement gFOBT testing in order to satisfy the requests from Clinical Commissioning Groups that will be arising as a result of the NICE guideline.…”

mentioning

confidence: 99%

NICE referral guidelines for suspected cancer: colorectal cancer and faecal occult blood testing

Benton

Steele²,

Logan

et al. 2015

Ann Clin Biochem

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An urgent referral strategy for symptomatic patients with suspected colorectal cancer based on a quantitative immunochemical faecal occult blood test

Cited by 53 publications

References 29 publications

Setting up a service for a faecal immunochemical test for haemoglobin (FIT): a review of considerations, challenges and constraints

Setting up a service for a faecal immunochemical test for haemoglobin (FIT): a review of considerations, challenges and constraints

Proton pump inhibitors reduce the accuracy of faecal immunochemical test for detecting advanced colorectal neoplasia in symptomatic patients

NICE referral guidelines for suspected cancer: colorectal cancer and faecal occult blood testing

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