Diagnostic accuracy of one or two faecal haemoglobin and calprotectin measurements in patients with suspected colorectal cancer

Turvill, James; Mellen, Samantha; Jeffery, Laura; Bevan, Sarah; Keding, Ada; Turnock, Daniel

doi:10.1080/00365521.2018.1539761

Cited by 41 publications

(55 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Studies on single tests of OC-Sensor and HM-JackArc at various cut-offs have shown similarly high values of NPVs as in this study at 99-100% [5][6][7][8]. Our findings confirm another recent study showing there is no advantage for diagnostic accuracy of using two versus one FIT [16]. A recent health technology assessment report summarized that faecal immunochemical tests are useful to rule out CRC and triage based on f-Hb concentration may turn up to 75% of colonoscopies in referred patients avoidable, which would be cost-effective compared to no triage [15].…”

Section: Discussionsupporting

confidence: 90%

Diagnostic accuracy of a quantitative faecal immunochemical test vs. symptoms suspected for colorectal cancer in patients referred for colonoscopy

Tsapournas

Hellström

Cao

et al. 2020

Scandinavian Journal of Gastroenterology

View full text Add to dashboard Cite

Objective: Determine diagnostic accuracy of a quantitative faecal immunochemical haemoglobin test (QuikRead go V R FIT, Orion Diagnostica Oy) in symptomatic patients referred for colonoscopy, at various cutoffs and for one or two tests. Methods: Patients referred to four endoscopy units in mid-Sweden between 2013 and 2017 provided information on lower abdominal symptoms and faecal samples from two separate days prior to colonoscopy. Results: In all, 5.4% (13/242) patients had colorectal cancer (CRC). For one FIT at cutoff 10 mg Hb/g faeces, sensitivity for CRC was 92% (95% CI 78-100%) and specificity 77% (95% CI 72-83%); equal to 74%; 95% CI 68-80 (178/242) colonoscopies potentially avoidable and one CRC missed. Based on the maximal outcome of two FITs, sensitivity was 100%, specificity 71% (66-77%) and 68%; 95% CI 62-74 (160/237) colonoscopies potentially avoidable. Among 17% (42/242) patients with one FIT of >200 mg Hb/g faeces, 85% (11/13) had CRC. Positive predictive values of FIT varied 16.9-26.2% depending on cutoff and one or two FITs, whereas NPVs were 99% and above in all scenarios. In 60 patients reporting rectal bleeding, one FIT at cutoff 10 mg Hb/g discriminated well between CRC and other conditions (p ¼ .001). In regression models, FIT was more important than age, sex and all symptoms. Conclusion: One or two FITs in symptomatic patients referred for colonoscopy imply powerful risk stratification abilities for CRC, even among patients reporting rectal bleeding. Larger studies in various settings will clarify how to make the best use of this opportunity.

show abstract

Section: Discussionsupporting

confidence: 90%

Diagnostic accuracy of a quantitative faecal immunochemical test vs. symptoms suspected for colorectal cancer in patients referred for colonoscopy

Tsapournas

Hellström

Cao

et al. 2020

Scandinavian Journal of Gastroenterology

View full text Add to dashboard Cite

show abstract

“…Further studies have reported on the use of quantitative FITs on symptomatic patients who have already been referred. The authors found five studies [25][26][27][28][29] indicating similar CRC prevalence (2.1%-5.2%) as in the present study, with patients aged ≥16 years or ≥18 years who underwent endoscopy; one-sample FITs with cut-offs of 10-15 µg/g faeces were used in these studies and they presented sensitivities of 84.6%-100%, specificities of 76.5%-93.9%, and PPVs of 7.6%-28.6%.…”

Section: Discussionmentioning

confidence: 99%

Diagnosing colorectal cancer in primary care: cohort study in Sweden of qualitative faecal immunochemical tests, haemoglobin levels, and platelet counts

Högberg¹,

Gunnarsson

Jansson

et al. 2020

Br J Gen Pract

View full text Add to dashboard Cite

BackgroundColorectal cancer (CRC) diagnostics are challenging in primary care and reliable diagnostic aids are desired. Qualitative faecal immunochemical tests (FITs) have been used for suspected CRC in Sweden since the mid-2000s, but evidence regarding their effectiveness is scarce. Anaemia and thrombocytosis are both associated with CRC.AimTo evaluate the usefulness of qualitative FITs requested for symptomatic patients in primary care, alone and combined with findings of anaemia and thrombocytosis, in the diagnosis of CRC.Design and settingA population-based cohort study using electronic health records and data from the Swedish Cancer Register, covering five Swedish regions.MethodPatients aged ≥18 years in the five regions who had provided FITs requested by primary care practitioners from 1 January 2015 to 31 December 2015 were identified. FIT and blood-count data were registered and all CRC diagnoses made within 2 years were retrieved. Diagnostic measurements were calculated.ResultsIn total, 15 789 patients provided FITs (four different brands); of these patients, 304 were later diagnosed with CRC. Haemoglobin levels were available for 13 863 patients, and platelet counts for 10 973 patients. Calculated for the different FIT brands only, the sensitivities for CRC were 81.6%–100%; specificities 65.7%–79.5%; positive predictive values 4.7%–8.1%; and negative predictive values 99.5%–100%. Calculated for the finding of either a positive FIT or anaemia, the sensitivities increased to 88.9–100%. Adding thrombocytosis did not further increase the diagnostic performance.ConclusionQualitative FITs requested in primary care seem to be useful as rule-in tests for referral when CRC is suspected. A negative FIT and no anaemia indicate a low risk of CRC.

show abstract

“…In a previous study (15) of the diagnostic accuracy of one vs two specimens it was concluded that two specimens offered no advantage over one specimen. Sequential results of 400 µg/g were sometimes followed by <10 µg/g from the same patient taken a median of 6 days apart.…”

Section: Comparisons To Previous Literaturementioning

confidence: 98%

Faecal immunochemical testing (FIT): Sources of analytical variation based on three years of routine testing in the context of DG30

James

Nicholson

Marr

et al. 2020

Preprint

View full text Add to dashboard Cite

words)Aims: To determine analytical capabilities of a commonly used faecal immunochemical test (FIT) to detect haemoglobin (Hb) in the context of NICE guidance DG30, and the likely use of FIT to reprioritise patients delayed by the COVID-19 pandemic.Methods: Data obtained from independent verification studies and clinical testing of the HM-JACKarc FIT method in routine primary care practice were analysed to derive analytical performance characteristics.Results: Detection capabilities for the FIT method were 0.5 µg/g (limit of blank), 1.1 (limit of detection) and 15.0 µg/g (limit of quantification). 31 of 33 (94%) non-homogenised specimens analysed in triplicate were consistently categorised relative to 10 µg/g compared to all 33 (100%) homogenised specimens. Imprecision in non-homogenised specimens was higher (median 27.8%, (range 20.5% -48.6%)) than in homogenised specimens (10.

show abstract

Diagnostic accuracy of one or two faecal haemoglobin and calprotectin measurements in patients with suspected colorectal cancer

Cited by 41 publications

References 31 publications

Diagnostic accuracy of a quantitative faecal immunochemical test vs. symptoms suspected for colorectal cancer in patients referred for colonoscopy

Diagnostic accuracy of a quantitative faecal immunochemical test vs. symptoms suspected for colorectal cancer in patients referred for colonoscopy

Diagnosing colorectal cancer in primary care: cohort study in Sweden of qualitative faecal immunochemical tests, haemoglobin levels, and platelet counts

Faecal immunochemical testing (FIT): Sources of analytical variation based on three years of routine testing in the context of DG30

Contact Info

Product

Resources

About