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An observational study of replicate faecal immunochemical tests in the urgently referred symptomatic cohort

An observational study of replicate faecal immunochemical tests in the urgently referred... IntroductionTriage of patients with suspected colorectal cancer (CRC) utilises a single faecal immunochemical test (FIT) at a defined threshold. Limited evidence exists regarding whether replicate FIT improves the positive and negative predictive value in symptomatic patients. This study examines urgently referred symptomatic patients undergoing replicate FIT. Primary aim is to assess two FITs and CRC/serious bowel disease. Secondary aims are to determine correlation and utility of replicate FIT.MethodologyPatients carried out one additional FIT during COVID-19 pandemic. FIT 1 and FIT 2 (the replicate sample) were analysed in relation to symptoms, diagnoses, investigations, future colonoscopy and missed CRC. Study period was 01/03/2020–31/07/2020. Three subgroups were compared; double positive (≥10 μg Hb/g faeces), double negative, and discordant FIT (one positive).Results111 patients had replicate FIT (50 male, 61 female). 43 (38.7%) patients had double negative, 32 (28.8%) double positive and 36 (32.4%) had discordant FITs. Median time between FITs was 14 days (IQR = 11–19). 83% of double positive patients underwent colonoscopy/virtual colonoscopy (61% in double negative patients). Six CRC and one high-risk polyp were in double positive patients (none in other groups). One discordant patient was not investigated and a CRC missed.ConclusionsReplicate FIT as a triage strategy appears most effective where both FITs are negative. CRC risk is low when FIT results are discordant. Double negative FITs are reassuring given benign associated diagnoses, or for patients where endoscopic investigation is high-risk. Larger studies are required to evaluate discordant FITs, enabling refinement of urgent investigation pathways. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Annals of Clinical Biochemistry: An International Journal of Biochemistry and Laboratory Medicine SAGE

An observational study of replicate faecal immunochemical tests in the urgently referred symptomatic cohort

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References (17)

Publisher
SAGE
Copyright
© The Author(s) 2023
ISSN
0004-5632
eISSN
1758-1001
DOI
10.1177/00045632231163425
Publisher site
See Article on Publisher Site

Abstract

IntroductionTriage of patients with suspected colorectal cancer (CRC) utilises a single faecal immunochemical test (FIT) at a defined threshold. Limited evidence exists regarding whether replicate FIT improves the positive and negative predictive value in symptomatic patients. This study examines urgently referred symptomatic patients undergoing replicate FIT. Primary aim is to assess two FITs and CRC/serious bowel disease. Secondary aims are to determine correlation and utility of replicate FIT.MethodologyPatients carried out one additional FIT during COVID-19 pandemic. FIT 1 and FIT 2 (the replicate sample) were analysed in relation to symptoms, diagnoses, investigations, future colonoscopy and missed CRC. Study period was 01/03/2020–31/07/2020. Three subgroups were compared; double positive (≥10 μg Hb/g faeces), double negative, and discordant FIT (one positive).Results111 patients had replicate FIT (50 male, 61 female). 43 (38.7%) patients had double negative, 32 (28.8%) double positive and 36 (32.4%) had discordant FITs. Median time between FITs was 14 days (IQR = 11–19). 83% of double positive patients underwent colonoscopy/virtual colonoscopy (61% in double negative patients). Six CRC and one high-risk polyp were in double positive patients (none in other groups). One discordant patient was not investigated and a CRC missed.ConclusionsReplicate FIT as a triage strategy appears most effective where both FITs are negative. CRC risk is low when FIT results are discordant. Double negative FITs are reassuring given benign associated diagnoses, or for patients where endoscopic investigation is high-risk. Larger studies are required to evaluate discordant FITs, enabling refinement of urgent investigation pathways.

Journal

Annals of Clinical Biochemistry: An International Journal of Biochemistry and Laboratory MedicineSAGE

Published: Sep 1, 2023

Keywords: Gastrointestinal disorders, clinical studies; haemoglobin, analytes; cancer, clinical studies

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