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Colorectal
Original article
Faecal immunochemical testing (FIT) in symptomatic patients: what are we missing?
  1. Alexia Farrugia1,2,
  2. Monika Widlak2,3,
  3. Charles Evans1,
  4. Stephen Charles Smith4,5,
  5. Ramesh Arasaradnam2,3
  1. 1 Department of Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  2. 2 Warwick Medical School, University of Warwick, Warwick Medical School, Coventry, UK
  3. 3 Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  4. 4 Department of Clinical Biochemistry, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  5. 5 Midlands and North West Bowel Cancer Screening Hub, Coventry, UK
  1. Correspondence to Dr Ramesh Arasaradnam, Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; R.Arasaradnam{at}warwick.ac.uk

Abstract

Objective Faecal immunochemical test (FIT) shows promise as a non-invasive triage test for colorectal cancer (CRC) in the symptomatic population. The aim of this study was to assess the use of FIT within the recent NG12 and DG30 National Institute for Health and Care Excellence (NICE) guidelines.

Design A single-centre prospective study of patients referred to University Hospitals Coventry and Warwickshire NHS Trust via the 2-week wait (TWW) pathway between January 2015 and March 2016 was conducted. 612 patients were reviewed, of which 519 were found to meet the NG12 criteria and 79 met the DG30 criteria. Data included age, sex, symptoms, colonoscopy or CT colonography, histology and FIT results.

Main outcome measures FIT was performed in all patients and sensitivity, specificity, positive predictive value and negative predictive value, with 95% CI, for cancers and adenomas within each pathway (TWW, NG12 and DG30) was calculated.

Results CRC sensitivity in TWW pathway patients, NG12 and DG30 group was 86.84% (95% CI 71.91% to 95.59%), 84.85% (95% CI 68.1% to 94.89%) and 100% (95% CI 47.82% to 100%), respectively. Specificity was 82.23% (95% CI 78.85% to 85.27%), 81.28% (95% CI 77.52% to 84.65%) and 91.89% (95% CI 83.18% to 96.97%), respectively. Adenoma sensitivity in the groups was 30.69% (95% CI 29.9% to 40.66%), 30.77% (95% CI 21.51% to 41.32%) and 25% (95% CI 3.19% to 65.09%), respectively.

Conclusion Use of FIT within the remit of the NG12 NICE guidelines shows a high sensitivity and specificity and may be an effective triage tool when considering whether to perform investigations. However, there is still a miss rate. FIT within DG30 has excellent sensitivity and improved specificity; however, DG30 targets lower risk groups and accounts for only 13% of the entire referrals for suspected cancer. Therefore, managing the larger, higher risk NG12 group may require the addition of another test or marker to ensure that CRC is not missed.

  • colorectal cancer
  • colorectal adenomas
  • screening

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/flgastro-2018-101174

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    Footnotes

    • Contributors AF contributed to data analysis and writing of the manuscript. MW led the FAMISHED 2WW project, recruited patients and collected data. SCS supervised FIT laboratory analysis. RA obtained funding. CE and RA planned the study. MW, CE, SCS and RA reviewed the manuscript.

    • Funding BDRF as part of the FAMISHED study.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data are available upon reasonable request.