Assuring the quality of examinations using faecal immunochemical tests for haemoglobin (FIT)

Fraser, Callum G.

doi:10.1515/cclm-2020-1509

Cited by 1 publication

(2 citation statements)

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“…Such strategies are associated with fewer false negative results but with a concomitant need for more invasive investigations. Furthermore, there have been concerns that the imprecision of f-Hb at such concentrations with current techniques may lead to spurious results [21]. Whilst FIT alone has been shown to be a very accurate predictor of colorectal cancer in symptomatic patients, there is a small rate of false negative results which could lead to missed cancer diagnoses.…”

Section: Discussionmentioning

confidence: 99%

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Combining the quantitative faecal immunochemical test and full blood count reliably rules out colorectal cancer in a symptomatic patient referral pathway

Johnstone

Burton

Kourounis

et al. 2021

Int J Colorectal Dis

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Purpose Faecal Immunochemical Test (FIT) has proven utility for Colorectal Cancer (CRC) detection in symptomatic patients. Most studies have examined FIT in symptomatic patients subsequently referred from primary care. We investigated associations between CRC and FIT in both referred and non-referred symptomatic patients. Methods A retrospective, observational study of all patients with a FIT submitted Aug 2018 to Jan 2019 in NHS GG&C was performed. Referral to colorectal/gastroenterology and decision to perform colonoscopy were recorded. FIT results were grouped as f-Hb < 10/10–149/150–399/ ≥ 400 μg/g. The MCN cancer registry identified new cases of CRC. Covariables were compared using the χ2 test. Multivariate binary logistic regression identified independent predictors of CRC. Results A total of 4968 patients were included. Raised FIT correlated with decision to refer (p < 0.001) and scope (p < 0.001). With 23-month median follow-up, 61 patients were diagnosed with CRC. These patients were older (median 69 vs 59 years, cancer and no cancer respectively, p = 0.001), more likely to be male (55.7% vs 42.1%, p = 0.033), and to report rectal bleeding (51.7% vs 36.1%, p = 0.013). FIT (< 10 µg/g 8.2% vs 76.7% and ≥ 400 µg/g 55.7% vs 3.8%, p < 0.001) and anaemia (45.9% vs 19.7%, p < 0.001) were associated with CRC. On multivariate analysis, age (p = 0.023), male sex (p = 0.04), FIT (≥ 400 OR 54.256 (95% CI:20.683–142.325; p < 0.001)), and anaemia (OR 1.956 (1.071–3.574; p = 0.029)) independently predicted CRC. One patient (0.04%) with a negative FIT and normal haemoglobin had CRC. Conclusion GP referral and secondary care investigation patterns were influenced by FIT. The combination of normal Hb and f-Hb excluded CRC in 99.96% of cases, providing excellent reassurance to those prioritising access to endoscopy services.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%