Detection capability of quantitative faecal immunochemical tests for haemoglobin (FIT) and reporting of low faecal haemoglobin concentrations

Callum G. Fraser (Lead / Corresponding author), Sally C. Benton

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)
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Faecal immunochemical tests for haemoglobin (FIT) are widely used in asymptomatic population screening for colorectal (bowel) cancer. FIT are also used to assist with the assessment of patients presenting with lower abdominal symptoms. Quantitative FIT allow the generation of numerical estimates of faecal haemoglobin (f-Hb) concentrations. There is now great interest in "low" f-Hb concentrations in these clinical settings: in consequence, knowledge of the detection capability is very important for f-Hb concentration examinations. There are a number of current problems associated with the reporting of low f-Hb concentrations and wide misunderstanding of the metrological aspects of examinations of f-Hb at low concentrations. These would be solved if the detectability characteristics of f-Hb concentration examinations, namely, the limit of blank (LoB), limit of detection (LoD) and limit of quantitation (LoQ), were generated, validated and used in reporting systems exactly as recommended in the EP17-A2 guideline of the Clinical Laboratory Standards Institute. LoB and LoD are statistical concepts, but the LoQ depends on definition of analytical performance specifications (APS). In this Opinion Paper proposals for interim APS are made, based on the current state of the art achieved with examinations of faecal samples. It is proposed that LoQ is determined at an examination imprecision of CV≤10% using faecal samples naturally positive for Hb rather than faeces spiked with haemolysate. Detailed proposals for reporting f-Hb data at low concentrations are also made.

Original languageEnglish
Pages (from-to)611-616
Number of pages6
JournalClinical Chemistry and Laboratory Medicine (CCLM)
Issue number5
Early online date11 Jul 2018
Publication statusPublished - 7 Nov 2018


  • detection capability
  • faecal haemoglobin
  • faecal immunochemical test
  • limit of blank
  • limit of detection
  • limit of quantitation

ASJC Scopus subject areas

  • Clinical Biochemistry
  • Biochemistry, medical


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