Faecal calprotectin in patients with suspected colorectal cancer: a diagnostic accuracy study

Abstract

has the potential to increase colorectal cancer detection rate yet be clinically and cost effective.

Faecal calprotectin effectively excludes inflammatory bowel disease in 789 symptomatic young adults with/without alarm symptoms: a prospective UK primary care cohort study

“…Further improvements in PPV by raising the cut‐off above 100 μg/g are offset by increased missed cases of organic intestinal disease. Overall, based on this data and work from others, we advocate a threshold for referral of 100 μg/g …”

“…Indeed, the presence of alarm symptoms, which raise the pre‐test probability of IBD, may be crucial to the successful application of calprotectin diagnostic pathways in primary care; without which the PPV of calprotectin may too low to be clinically useful in identifying IBD . Further research is required to establish how calprotectin will integrate with faecal immunochemical testing (FIT), in particular in older age‐groups than included here …”

“…By using a cal- findings are similar to those reported in the Brighton study (14% mis-rate at 100 lg/g) 11 Overall, based on this data and work from others, we advocate a threshold for referral of 100 lg/g. 10,11,20…”

“…21 Further research is required to establish how calprotectin will integrate with faecal immunochemical testing (FIT), in particular in older age-groups than included here. 20,[23][24][25] Our service evaluation demonstrates that faecal calprotectin is a clinically useful primary care test to distinguish IBD and organic intestinal disease as a whole from functional gut disorder in patients aged less than 46. However, simply introducing the pathway is not sufficient to either maximise gains, or guarantee its success.…”

Poor predictive value of lower gastrointestinal alarm features in the diagnosis of colorectal cancer in 1981 patients in secondary care

“…Although current NICE criteria for referral with suspected CRC performed satisfactorily with a PPV of >3%, the benchmark proposed by the guideline development group, it should be remembered that the patient cohort in our study will likely have a higher prevalence of CRC than a primary care population, and that the diagnostic value of these referral criteria are therefore probably overestimations. Developments in the broader field of CRC diagnosis and management such as new routes of screening, or combining symptoms with biomarkers, and increased evidence for the efficacy of some chemopreventive agents, as well as both primary and secondary prevention at the public health level, may prove more effective methods to reduce both the human and economic cost of CRC at the population level.…”