Stephen T McSorley1, Jayne Digby2, Danielle Clyde3, Neil Cruickshank3, Paul Burton4, Louise Barker3, Judith A Strachan5, Callum G Fraser2, Karen Smith6, Craig Mowat7, Jack Winter8, Robert J C Steele2. 1. Academic Unit of Surgery, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK. 2. Centre for Research into Cancer Prevention and Screening, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK. 3. Department of Surgery, NHS Fife, Victoria Hospital, Kirkcaldy, UK. 4. eHealth, Corporate Services, Business Intelligence, NHS Greater Glasgow and Clyde, Glasgow, UK. 5. Department of Blood Sciences, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK. 6. Department of Clinical Biochemistry, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, UK. 7. Department of Gastroenterology, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK. 8. Department of Gastroenterology, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK.
Abstract
AIM: Lower gastrointestinal (GI) symptoms are poor predictors of colorectal cancer (CRC). The aim of this study was to examine the diagnostic yield of colonoscopy by faecal haemoglobin (f-Hb) concentration in symptomatic patients assessed in primary care by faecal immunochemical testing (FIT). METHOD: In three Scottish NHS Boards, FIT kits (HM-JACKarc, Hitachi Chemical Diagnostics Systems Co., Ltd, Tokyo, Japan) were used by general practitioners to guide referrals for patients with lower GI symptoms (laboratory data studied for 12 months from December 2015 onwards in Tayside, 18 months from June 2018 onwards in Fife and 5 months from September 2018 onwards in Greater Glasgow and Clyde). Cases of CRC diagnosed at colonoscopy were ascertained from colonoscopy and pathology records. RESULTS: Four thousand eight hundred and forty one symptomatic patients who underwent colonoscopy after FIT submission were included. Of the 2166 patients (44.7%) with f-Hb <10 µg Hb/g faeces (µg/g), 14 (0.6%) were diagnosed with CRC, with a number needed to scope (NNS) of 155. Of the 2675 patients (55.3%) with f-Hb ≥10 µg/g, 252 were diagnosed with CRC (9.4%) with a NNS of 11. Of the 705 patients with f-Hb ≥400 µg/g, 158 (22.4%) were diagnosed with CRC with a NNS of 5. Over half of those diagnosed with CRC with f-Hb <10 µg/g had coexisting anaemia. CONCLUSION: Symptomatic patients with f-Hb ≥10 µg/g should undergo further investigation for CRC, while higher f-Hb concentrations could be used to triage for urgency during the COVID-19 recovery phase. Patients with f-Hb <10 µg/g and without anaemia are very unlikely to be diagnosed with CRC and the majority need no further investigation.
AIM: Lower gastrointestinal (GI) symptoms are poor predictors of colorectal cancer (CRC). The aim of this study was to examine the diagnostic yield of colonoscopy by faecal haemoglobin (f-Hb) concentration in symptomatic patients assessed in primary care by faecal immunochemical testing (FIT). METHOD: In three Scottish NHS Boards, FIT kits (HM-JACKarc, Hitachi Chemical Diagnostics Systems Co., Ltd, Tokyo, Japan) were used by general practitioners to guide referrals for patients with lower GI symptoms (laboratory data studied for 12 months from December 2015 onwards in Tayside, 18 months from June 2018 onwards in Fife and 5 months from September 2018 onwards in Greater Glasgow and Clyde). Cases of CRC diagnosed at colonoscopy were ascertained from colonoscopy and pathology records. RESULTS: Four thousand eight hundred and forty one symptomatic patients who underwent colonoscopy after FIT submission were included. Of the 2166 patients (44.7%) with f-Hb <10 µg Hb/g faeces (µg/g), 14 (0.6%) were diagnosed with CRC, with a number needed to scope (NNS) of 155. Of the 2675 patients (55.3%) with f-Hb ≥10 µg/g, 252 were diagnosed with CRC (9.4%) with a NNS of 11. Of the 705 patients with f-Hb ≥400 µg/g, 158 (22.4%) were diagnosed with CRC with a NNS of 5. Over half of those diagnosed with CRC with f-Hb <10 µg/g had coexisting anaemia. CONCLUSION: Symptomatic patients with f-Hb ≥10 µg/g should undergo further investigation for CRC, while higher f-Hb concentrations could be used to triage for urgency during the COVID-19 recovery phase. Patients with f-Hb <10 µg/g and without anaemia are very unlikely to be diagnosed with CRC and the majority need no further investigation.
Authors: Kevin J Monahan; Michael M Davies; Muti Abulafi; Ayan Banerjea; Brian D Nicholson; Ramesh Arasaradnam; Neil Barker; Sally Benton; Richard Booth; David Burling; Rachel Victoria Carten; Nigel D'Souza; James Edward East; Jos Kleijnen; Michael Machesney; Maria Pettman; Jenny Pipe; Lance Saker; Linda Sharp; James Stephenson; Robert Jc Steele Journal: Gut Date: 2022-07-12 Impact factor: 31.793
Authors: Craig Mowat; Jayne Digby; Judith A Strachan; Rebecca K McCann; Francis A Carey; Callum G Fraser; Robert Jc Steele Journal: Ann Clin Biochem Date: 2021-01-21 Impact factor: 2.057
Authors: Mark S Johnstone; Paul Burton; Georgios Kourounis; Jack Winter; Emilia Crighton; David Mansouri; Paul Witherspoon; Karen Smith; Stephen T McSorley Journal: Int J Colorectal Dis Date: 2021-12-21 Impact factor: 2.571
Authors: Diana R Withrow; Brian Shine; Jason Oke; Andres Tamm; Tim James; Eva Morris; Jim Davies; Steve Harris; James E East; Brian D Nicholson Journal: BMC Med Date: 2022-03-15 Impact factor: 8.775
Authors: Mark S Johnstone; Gillian Miller; Grace Pang; Paul Burton; Georgios Kourounis; Jack Winter; Emilia Crighton; David Mansouri; Paul Witherspoon; Karen Smith; Stephen T McSorley Journal: Ann Clin Biochem Date: 2022-03-03 Impact factor: 2.587