N D'Souza1,2,3, T Georgiou Delisle1,4, M Chen5, S C Benton6, M Abulafi1. 1. Department of Colorectal Surgery, Croydon University Hospital, Croydon, UK. 2. Department of Colorectal Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 3. Department of Surgery and Cancer, Imperial College London, London, UK. 4. School of Public Health, Imperial College London, London, UK. 5. Department of Research and Development, RM Partners, West London Cancer Alliance, London, UK. 6. Department of Biochemistry, Royal Surrey County Hospital, Guildford, UK.
Abstract
BACKGROUND: This study investigated whether a quantitative faecal immunochemical test (FIT) could be used to select patients with either high- or low-risk symptoms of colorectal cancer for urgent investigation. METHODS: A double-blinded diagnostic accuracy study was conducted in 50 hospitals in England between October 2017 and December 2019. Patients were eligible for inclusion if they had been referred to secondary care with suspected colorectal cancer symptoms meeting national criteria for urgent referral and triaged to investigation with colonoscopy. RESULTS: The study included 9822 patients, of whom 7194 (73.2 per cent) had high-risk symptoms, 1994 (20.3 per cent) low-risk symptoms, and 634 (6.5 per cent) had other symptoms warranting urgent referral. In patients with high-risk symptoms, the sensitivity of FIT for colorectal cancer at cut-off values of 2 and 10 μg haemoglobin per g faeces was 97.7 (95 per cent c.i. 95.0 to 99.1) and 92.2 (88.2 to 95.2) per cent respectively, compared with 94.3 (84.3 to 98.8) and 86.8 (74.7 to 94.5) per cent in patients with low-risk symptoms at the same cut-off points. At cut-off values of 2, 10, and 150 μg/g, the positive predictive value for colorectal cancer was 8.9, 16.2, and 30.5 per cent respectively for those with high-risk symptoms, and 8.4, 16.9, and 35.5 per cent for those with low-risk symptoms. CONCLUSION: FIT safely selects patients with high or low risk symptoms of colorectal cancer for investigation.
BACKGROUND: This study investigated whether a quantitative faecal immunochemical test (FIT) could be used to select patients with either high- or low-risk symptoms of colorectal cancer for urgent investigation. METHODS: A double-blinded diagnostic accuracy study was conducted in 50 hospitals in England between October 2017 and December 2019. Patients were eligible for inclusion if they had been referred to secondary care with suspected colorectal cancer symptoms meeting national criteria for urgent referral and triaged to investigation with colonoscopy. RESULTS: The study included 9822 patients, of whom 7194 (73.2 per cent) had high-risk symptoms, 1994 (20.3 per cent) low-risk symptoms, and 634 (6.5 per cent) had other symptoms warranting urgent referral. In patients with high-risk symptoms, the sensitivity of FIT for colorectal cancer at cut-off values of 2 and 10 μg haemoglobin per g faeces was 97.7 (95 per cent c.i. 95.0 to 99.1) and 92.2 (88.2 to 95.2) per cent respectively, compared with 94.3 (84.3 to 98.8) and 86.8 (74.7 to 94.5) per cent in patients with low-risk symptoms at the same cut-off points. At cut-off values of 2, 10, and 150 μg/g, the positive predictive value for colorectal cancer was 8.9, 16.2, and 30.5 per cent respectively for those with high-risk symptoms, and 8.4, 16.9, and 35.5 per cent for those with low-risk symptoms. CONCLUSION: FIT safely selects patients with high or low risk symptoms of colorectal cancer for 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: 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: 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