Combining the quantitative faecal immunochemical test and full blood count reliably rules out colorectal cancer in a symptomatic patient referral pathway

Johnstone, M. S., Burton, P., Kourounis, G. , Winter, J., Crighton, E., Mansouri, D. , Witherspoon, P., Smith, K. and McSorley, S. T. (2022) Combining the quantitative faecal immunochemical test and full blood count reliably rules out colorectal cancer in a symptomatic patient referral pathway. International Journal of Colorectal Disease, 37(2), pp. 457-466. (doi: 10.1007/s00384-021-04079-2) (PMID:34932152) (PMCID:PMC8803704)

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Abstract

Purpose: Faecal Immunochemical Test (FIT) has proven utility for Colorectal Cancer (CRC) detection in symptomatic patients. Most studies have examined FIT in symptomatic patients subsequently referred from primary care. We investigated associations between CRC and FIT in both referred and non-referred symptomatic patients. Methods: A retrospective, observational study of all patients with a FIT submitted Aug 2018 to Jan 2019 in NHS GG&C was performed. Referral to colorectal/gastroenterology and decision to perform colonoscopy were recorded. FIT results were grouped as f-Hb < 10/10–149/150–399/ ≥ 400 μg/g. The MCN cancer registry identified new cases of CRC. Covariables were compared using the χ2 test. Multivariate binary logistic regression identified independent predictors of CRC. Results: A total of 4968 patients were included. Raised FIT correlated with decision to refer (p < 0.001) and scope (p < 0.001). With 23-month median follow-up, 61 patients were diagnosed with CRC. These patients were older (median 69 vs 59 years, cancer and no cancer respectively, p = 0.001), more likely to be male (55.7% vs 42.1%, p = 0.033), and to report rectal bleeding (51.7% vs 36.1%, p = 0.013). FIT (< 10 µg/g 8.2% vs 76.7% and ≥ 400 µg/g 55.7% vs 3.8%, p < 0.001) and anaemia (45.9% vs 19.7%, p < 0.001) were associated with CRC. On multivariate analysis, age (p = 0.023), male sex (p = 0.04), FIT (≥ 400 OR 54.256 (95% CI:20.683–142.325; p < 0.001)), and anaemia (OR 1.956 (1.071–3.574; p = 0.029)) independently predicted CRC. One patient (0.04%) with a negative FIT and normal haemoglobin had CRC. Conclusion: GP referral and secondary care investigation patterns were influenced by FIT. The combination of normal Hb and f-Hb excluded CRC in 99.96% of cases, providing excellent reassurance to those prioritising access to endoscopy services.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mansouri, Mr David and Johnstone, Mr Mark and Kourounis, Dr Georgios and Winter, Dr Jack and Witherspoon, Mr Paul and McSorley, Dr Stephen and Smith, Ms Karen
Authors: Johnstone, M. S., Burton, P., Kourounis, G., Winter, J., Crighton, E., Mansouri, D., Witherspoon, P., Smith, K., and McSorley, S. T.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:International Journal of Colorectal Disease
Publisher:Springer
ISSN:0179-1958
ISSN (Online):1432-1262
Published Online:21 December 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in International Journal of Colorectal Disease 37(2): 457-466
Publisher Policy:Reproduced under a Creative Commons License

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