Faecal immunochemical tests (FIT) can help to rule out colorectal cancer in patients presenting in primary care with lower abdominal symptoms: a systematic review conducted to inform new NICE DG30 diagnostic guidance

Marie Westwood (Lead / Corresponding author), Shona Lang, Nigel Armstrong, Sietze van Turenhout, Joaquín Cubiella, Lisa Stirk, Isaac Corro Ramos, Marianne Luyendijk, Remziye Zaim, Jos Kleijnen, Callum G. Fraser

    Research output: Contribution to journalReview article

    36 Citations (Scopus)
    212 Downloads (Pure)

    Abstract

    Objective: To assess the effectiveness of quantitative faecal immunochemical tests (FIT) for triage of people presenting with lower abdominal symptoms, where a referral to secondary care for investigation of suspected colorectal cancer (CRC) is being considered, particularly when the two week criteria are not met.

    Methods: We conducted a systematic review following published guidelines for systematic reviews of diagnostic tests. Twenty-one resources were searched to March 2016. Summary estimates were calculated using a bivariate model, or random effects logistic regression model.

    Results: Nine studies are included in this review one additional study, included in our systematic review, was provided as 'academic in confidence' and cannot be described herein. When FIT was based on a single faecal sample and a cut-off of 10 µg Hb/g faeces, sensitivity estimates indicated that a negative result using either OC-Sensor or HMJACKarc may be adequate to rule out nearly all CRC; the summary estimate of sensitivity for OC-Sensor was 92.1% (95% CI: 86.9 to 95.3%), based on four studies (n = 4091 participants, 176 with CRC), and the only study of HM-JACKarc to assess the 10 µg Hb/g faeces cut-off (n = 507 participants, 11 with CRC) reported a sensitivity of 100% (95% CI: 71.5 to 100%). The corresponding specificity estimates were 85.8% (95% CI: 78.3 to 91.0%) and 76.6% (95% CI: 72.6 to 80.3%), respectively. When the diagnostic criterion was changed to include lower grades of neoplasia i.e., the target condition included higher-risk adenoma (HRA) as well as CRC, the rule-out performance of both FIT assays was reduced.

    Conclusions: There is evidence to suggest that triage using FIT at a cut-off around 10 µg Hb/g faeces has the potential to correctly rule-out CRC and avoid colonoscopy in 75 to 80% of symptomatic patients.
    Original languageEnglish
    Article number189
    Pages (from-to)1-17
    Number of pages17
    JournalBMC Medicine
    Volume15
    DOIs
    Publication statusPublished - 24 Oct 2017

    Keywords

    • Gastroenterology

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