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Faecal immunochemical test is superior to symptoms in predicting pathology in patients with suspected colorectal cancer symptoms referred on a 2WW pathway: a diagnostic accuracy study.

Authors
  • D'Souza, Nigel1, 2, 3
  • Georgiou Delisle, Theo1, 3
  • Chen, Michelle4
  • Benton, Sally5
  • Abulafi, Muti6
  • 1 Colorectal Surgery, Croydon University Hospital, Croydon, UK.
  • 2 Colorectal Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, UK.
  • 3 Surgery & Cancer, Imperial College London, London, UK.
  • 4 Research & Development, RM Partners, London, UK.
  • 5 Clinical Biochemistry, Royal Surrey County Hospital, Guildford, UK.
  • 6 Colorectal Surgery, Croydon University Hospital, Croydon, UK [email protected]
Type
Published Article
Journal
Gut
Publisher
BMJ
Publication Date
Jun 01, 2021
Volume
70
Issue
6
Pages
1130–1138
Identifiers
DOI: 10.1136/gutjnl-2020-321956
PMID: 33087488
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To assess whether a faecal immunochemical test (FIT) could be used to select patients with suspected colorectal cancer (CRC) symptoms for urgent investigation. Multicentre, double-blinded diagnostic accuracy study in 50 National Health Service (NHS) hospitals across England between October 2017 and December 2019. Patients referred to secondary care with suspected CRC symptoms meeting NHS England criteria for urgent 2 weeks wait referral and triaged to investigation with colonoscopy were invited to perform a quantitative FIT. The sensitivity of FIT for CRC, and effect of relevant variables on its diagnostic accuracy was assessed. 9822 patients were included in the final analysis. The prevalence of CRC at colonoscopy was 3.3%. The FIT positivity decreased from 37.2% to 19.0% and 7.6%, respectively, at cut-offs of 2, 10 and 150 µg haemoglobin/g faeces (µg/g). The positive predictive values of FIT for CRC at these cut-offs were 8.7% (95% CI, 7.8% to 9.7%), 16.1% (95% CI 14.4% to 17.8%) and 31.1% (95% CI 27.8% to 34.6%), respectively, and the negative predictive values were 99.8% (95% CI 99.7% to 99.9%), 99.6% (95% CI 99.5% to 99.7%) and 98.9% (95% CI 98.7% to 99.1%), respectively. The sensitivity of FIT for CRC decreased at the same cut-offs from 97.0% (95% CI 94.5% to 98.5%) to 90.9% (95% CI 87.2% to 93.8%) and 70.8% (95% CI 65.6% to 75.7%), respectively, while the specificity increased from 64.9% (95% CI 63.9% to 65.8%) to 83.5% (95% CI 82.8% to 84.3%) and 94.6% (95% CI 94.1% to 95.0%), respectively. The area under the receiver operating characteristic curve was 0.93 (95% CI 0.92 to 0.95). FIT sensitivity is maximised to 97.0% at the lowest cut-off (2 µg/g); a negative FIT result at this cut-off can effectively rule out CRC and a positive FIT result is better than symptoms to select patients for urgent investigations. ISRCTN49676259. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

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