Double faecal immunochemical testing in patients with symptoms suspicious of colorectal cancer

Gerrard, A. D. et al. (2023) Double faecal immunochemical testing in patients with symptoms suspicious of colorectal cancer. British Journal of Surgery, 110(4), pp. 471-480. (doi: 10.1093/bjs/znad016) (PMID:36785496)

Abstract

Background: Faecal immunochemical test (FIT)-directed pathways based on a single test have been implemented for symptomatic patients. However, with a single test, the sensitivity is 87 per cent at 10 µg haemoglobin (Hb) per g faeces. This aims of this study were to define the diagnostic performance of a single FIT, compared with double FIT in symptomatic populations. Methods: Two sequential prospective patient cohorts referred with symptoms from primary care were studied. Patients in cohort 1 were sent a single FIT, and those in cohort 2 received two tests in succession before investigation. All patients were investigated, regardless of having a positive or negative test (threshold 10 µg Hb per g). Results: In cohort 1, 2260 patients completed one FIT and investigation. The sensitivity of single FIT was 84.1 (95 per cent c.i. 73.3 to 91.8) per cent for colorectal cancer and 67.4 (61.0 to 73.4) per cent for significant bowel pathology. In cohort 2, 3426 patients completed at least one FIT, and 2637 completed both FITs and investigation. The sensitivity of double FIT was 96.6 (90.4 to 99.3) per cent for colorectal cancer and 83.0 (77.4 to 87.8) per cent for significant bowel pathology. The second FIT resulted in a 50.0 per cent reduction in cancers missed by the first FIT, and 30.0 per cent for significant bowel pathology. Correlation between faecal Hb level was only modest (rs = 0.58), and 16.8 per cent of double tests were discordant, 11.4 per cent in patients with colorectal cancer and 18.3 per cent in those with significant bowel pathology. Conclusion: FIT in patients with high-risk symptoms twice in succession reduces missed significant colorectal pathology and has an acceptable workload impact.

• Item Type: Articles
• Additional Information: F.V.N.D. is supported by a senior fellowship from the Chief Scientist Office, Scotland (SCAF/16/01) and previously from Cancer Research UK (C26031/A11378). A.D.G. is funded by a fellowship from Scottish Government. E.T. is supported by a Cancer Research UK Career Development Fellowship (C31250/A22804). M.G.D. is supported by a Cancer Research UK programme grant (DRCPGM/100012) and previously C348/A18927.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Maeda, Miss Yasuko
• Authors: Gerrard, A. D., Maeda, Y., Miller, J., Gunn, F., Theodoratou, E., Noble, C., Porteous, L., Glancy, S., MacLean, P., Pattenden, R., Dunlop, M. G., Din, F. V. N., Clark, A., Collie, M., Collins, D., Duff, M., Goodbrand, S., Mander, J., Ventham, N., Paterson, H., Potter, M., Reddy, C., Speake, D., Shaban, F., Smith, G., and Vaughan-Shaw, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: British Journal of Surgery
• Publisher: Oxford University Press
• ISSN: 0007-1323
• ISSN (Online): 1365-2168
• Published Online: 14 February 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in British Journal of Surgery 110(4):471-480
• Publisher Policy: Reproduced under a Creative Commons licence