‘Low’ faecal immunochemical test (FIT) colorectal cancer: a 4‐year comparison of the Nottingham ‘4F’ protocol with FIT10 in symptomatic patients

Author:

Bailey J. A.12ORCID,Morton A. J.123ORCID,Jones J.1,Chapman C. J.4,Oliver S.5,Morling J. R.56,Patel H.5,Humes D. J.13ORCID,Banerjea A.1ORCID

Affiliation:

1. Nottingham Colorectal Service Nottingham University Hospitals NHS Trust Nottingham UK

2. Queens Medical Centre, School of Medicine University of Nottingham Nottingham UK

3. NIHR Nottingham Biomedical Research Centre (BRC) Nottingham University Hospitals NHS Trust and the University of Nottingham Nottingham UK

4. Eastern Hub, Bowel Cancer Screening Programme Nottingham University Hospitals NHS Trust Nottingham UK

5. NHS Nottingham and Nottinghamshire Integrated Care Board Nottingham UK

6. Lifespan and Population Health, School of Medicine University of Nottingham, City Hospital Nottingham UK

Abstract

AbstractAimThe aim of this work was to evaluate colorectal cancer (CRC) outcomes after ‘low’ (sub‐threshold) faecal immunochemical test (FIT) results in symptomatic patients tested in primary care.MethodThis work comprised a retrospective audit of 35 289 patients with FIT results who had consulted their general practitioner with lower gastrointestinal symptoms and had subsequent CRC diagnoses.The Rapid Colorectal Cancer Diagnosis pathway was introduced in November 2017 to allow incorporation of FIT into clinical practice. The local ‘4F’ protocol combined FIT results with blood tests and digital rectal examination (DRE): FIT, full blood count, ferritin and finger [DRE]. The outcome used was detection rates of CRC, missed CRC and time to diagnosis in local 4F protocols for patients with a subthreshold faecal haemoglobin (fHb) result compared with thresholds of 10 and 20 μg Hb/g faeces.ResultsA single threshold of 10 μg Hb/g faeces identifies a population in whom the risk of CRC is 0.2%, but this would have missed 63 (10.5%) of 599 CRCs in this population. The Nottingham 4F protocol would have missed fewer CRCs [42 of 599 (7%)] despite using a threshold of 20 μg Hb/g faeces for patients with normal blood tests. Subthreshold FIT results in patients subsequently diagnosed with a palpable rectal tumour yielded the longest delays in diagnosis.ConclusionA combination of FIT with blood results and DRE (the 4F protocol) reduced the risk of missed or delayed diagnosis. Further studies on the impact of such protocols on the diagnostic accuracy of FIT are expected. The value of adding blood tests to FIT may be restricted to specific parts of the fHb results spectrum.

Publisher

Wiley

Reference23 articles.

1. CancerResearchUK.Bowel cancer statistics. Available from:https://www.cancerresearchuk.org/health‐professional/cancer‐statistics/statistics‐by‐cancer‐type/bowel‐cancer. Accessed August 2023.

2. Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests

3. NICE.Suspected cancer: recognition and referral.2015NICE guidelines [NG12] (updated July 2017). Available from:https://www.nice.org.uk/guidance/ng12/chapter/Introduction. Accessed August 2023.

4. NICE.Quantitative faecal immunochemical tests to guide referral for colorectal cancer in primary care.2017Diagnostics guidance [DG30]. Available from:https://www.nice.org.uk/guidance/DG30. Accessed August 2023.

5. Faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC): a joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG)

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3