Role of the faecal immunochemical test in patients with risk-stratified suspected colorectal cancer symptoms: A systematic review and meta-analysis to inform the ACPGBI/BSG guidelines

Booth, Richard F.; Carten, Rachel; D’Souza, Nigel; Westwood, Marie; Kleijnen, Jos; Abulafi, Muti

doi:10.1016/j.lanepe.2022.100518

Cited by 11 publications

(8 citation statements)

References 45 publications

(45 reference statements)

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“…The study had comparable diagnostic accuracy data to the NICE FIT study which preceded it [6], and to other studies of FIT diagnostic accuracy in symptomatic patients [12][13][14]. In keeping with these studies and recent meta-analyses of FIT in symptomatic patients [7,15] a higher rate of CRC (5.7%) was observed in patients with f-Hb ≥9.5 μg/g compared to patients with f-Hb <9.5 μg/g (0.7%). In addition, equally high rates of CRC (5.8%) were observed in the patients referred without FIT due to GP's significant clinical concerns.…”

Section: Discussion and Con Clus Ionssupporting

confidence: 66%

“…The NICE FIT clinical trial was a multicentre diagnostic accuracy research study of 9822 patients with high‐ and low‐risk symptoms, which demonstrated FIT can detect and predict CRC and is superior to symptoms alone [6]. Further meta‐analysis has re‐iterated FIT to have high sensitivity for CRC in symptomatic patients [7]. Following the NICE FIT study results, a local, London borough‐wide service improvement project was developed to pilot FIT introduction into the 2‐week wait pathway for patients with suspected CRC symptoms in Croydon, before rolling out to the wider West London Cancer Alliance.…”

Section: Introductionmentioning

confidence: 99%

“…Further meta-analysis has re-iterated FIT to have high sensitivity for CRC in symptomatic patients [7]. Following the NICE FIT study results, a local, London borough-wide service improvement project was developed to pilot FIT introduction into the 2-week wait pathway for patients with suspected CRC symptoms in Croydon, before rolling out to the wider West London Cancer Alliance.…”

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confidence: 99%

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Introduction of an integrated primary care faecal immunochemical test referral pathway for patients with suspected colorectal cancer symptoms

et al. 2022

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Aim To determine the efficacy of a new 2‐week wait pathway that uses the faecal immunochemical test (FIT) in primary care to triage patients with high and low risk symptoms suspicious of colorectal cancer (CRC). This service improvement pilot follows 2017 National Institute for Health and Care Excellence guidance, that recommended using FIT to guide referral of patients with low risk, but not high risk symptoms, which continue to be referrred on the 2‐week pathway. Method Patients with high‐ and low‐risk CRC symptoms were tested with FIT and those with faecal haemoglobin (f‐Hb) ≥9.5 μg haemoglobin/g faeces (hereafter μg/g) were referred to secondary care. Results were tracked and primary care prompted to refer if timely referral was not made. Results Between December 2019 and October 2020, 5672 patients presented to primary care with high and/or low risk symptoms warranting investigations. Of these, 622 (11%) patients were referred without a FIT, of whom 36 (5.8%) had CRC. The remaining 5050 patients had a FIT, of which 4187 (83%) were processed to produce a quantitative result. Of these, 1085 patients (25.9%) had an f‐Hb ≥9.5 μg/g and of those, 982 patients (90.5%) were referred and 56 (5.7%) had CRC. A total of 3102 patients (74.1%) had an f‐Hb <9.5 μg/g, of which 456 (14.7%) were referred and three (0.7%) had CRC. A total of 97 cancers were diagnosed with a cancer prevalence of 1.7%. Conclusion A 2‐week wait pathway incorporating FIT as a triage tool can be implemented successfully in primary care to identify symptomatic patients at highest risk of CRC.

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Section: Discussion and Con Clus Ionssupporting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Introduction of an integrated primary care faecal immunochemical test referral pathway for patients with suspected colorectal cancer symptoms

et al. 2022

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“…A very recent systematic review including almost 5 million patients further supports the use of FIT to aid triage for colonoscopy [9]. Current expert evidence-based views around the use of FIT in the symptomatic population in the UK are detailed in the recently published joint guidelines from the Association of Coloproctology of Great Britain and Ireland and the British Society of Gastroenterology [10][11][12].…”

mentioning

confidence: 99%

Do risk scores improve use of faecal immunochemical testing for haemoglobin in symptomatic patients in primary care?

Digby,

Fraser,

Clark

et al. 2024

Colorectal Disease

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AimFaecal immunochemical testing (FIT) is used in the detection of colorectal cancer (CRC). FIT is invariably used at a single faecal haemoglobin (f‐Hb) concentration threshold. The aim of this observational study was to explore risk scoring models (RSMs) with f‐Hb and other risk factors for CRC in symptomatic patients attending primary care, potentially speeding diagnosis and saving endoscopy resources.MethodRecords of patients completing FIT were linked with The Scottish Cancer Registry and with other databases with symptoms, full blood count and demographic variables, and randomized into derivation and validation cohorts. Stepwise multivariable logistic regression created RSMs assessed in the validation cohort.ResultsOf 18 805 unique patients, 9374 and 9431 were in the derivation and validation cohorts, respectively: f‐Hb, male sex, increasing age, iron deficiency anaemia and raised systemic immune inflammation index created the final RSM. A risk score threshold of ≥2.363, generating the same number of colonoscopies as a f‐Hb threshold of ≥10 μg Hb/g gave improved sensitivity for CRC in both cohorts. A RSM which excluded f‐Hb was used to investigate the effect of raising the f‐Hb threshold from ≥10 to ≥20 μg Hb/g in those with a low risk score. This approach would have generated 234 fewer colonoscopies but missed four CRCs.ConclusionThe RSM conferred no significant benefit to patients with very low f‐Hb and CRC. Alternative strategies combining FIT with other variables may be more appropriate for safety‐netting of symptomatic patients. Further work to develop and investigate the value of RSM for significant bowel disease other than CRC may also be beneficial.

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“…Strategies are urgently needed to carefully manage colonoscopy workload while not adversely impacting patient care. In this issue of The Lancet Regional Health - Europe , Booth et al ., 4 present results from a meta-analysis that highlights the utility of the faecal immunochemical test (FIT) to triage symptomatic patients for colonoscopy. This is an important and timely review as many countries around the world feel the pressure of limited colonoscopy resources.…”

mentioning

confidence: 99%

FIT for colonoscopy: Benefits of the faecal immunochemical test for triaging symptomatic patients

Symonds

Winter

2022

The Lancet Regional Health - Europe

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Role of the faecal immunochemical test in patients with risk-stratified suspected colorectal cancer symptoms: A systematic review and meta-analysis to inform the ACPGBI/BSG guidelines

Cited by 11 publications

References 45 publications

Introduction of an integrated primary care faecal immunochemical test referral pathway for patients with suspected colorectal cancer symptoms

Introduction of an integrated primary care faecal immunochemical test referral pathway for patients with suspected colorectal cancer symptoms

Do risk scores improve use of faecal immunochemical testing for haemoglobin in symptomatic patients in primary care?

FIT for colonoscopy: Benefits of the faecal immunochemical test for triaging symptomatic patients

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