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Faecal Immunochemical Tests (FIT) for Haemoglobin for Timely Assessment of Patients with Symptoms of Colorectal Disease

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Timely Diagnosis of Colorectal Cancer

Abstract

Many patients present in primary healthcare with symptoms of serious colorectal disease (SCD), namely colorectal cancer (CRC), advanced adenoma and inflammatory bowel disease. However, SCD is present in only a small proportion. Colonoscopy is often a scarce resource and strategies to direct investigations to those who would benefit most would be advantageous. Guaiac-based faecal occult blood tests (gFOBT) have no role to play. However, there is now significant evidence that faecal immunochemical tests (FIT) for haemoglobin have many advantages. FIT are available in qualitative and quantitative test formats. Qualitative FIT could have some merits when used at home or in general practice or clinics: there is some evidence that these can be applied in both primary and secondary healthcare settings to detect CRC and rule-out most SCD, but they have many disadvantages. Quantitative FIT provide numerical estimates of faecal haemoglobin concentration (f-Hb). Studies have shown that, at low f-Hb cut-off, this test has high sensitivity for CRC and could be used as a rule-in test and prompt rapid referral for endoscopy. Perhaps more importantly, undetectable f-Hb provides considerable reassurance that SCD is absent and further investigation may not be required. Using both point-of care and quantitative methods, f-Hb has advantages over f-C in assessment of symptomatic patients. Risk-scoring models using f-Hb and other variables associated with SCD, especially age and sex, have been advocated. Although FIT have significant merits, no test is perfect and some cases of SCD will remain undetected; consequently safety-netting is required.

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Abbreviations

AA:

Advanced adenoma

ACRN:

Advanced colorectal neoplasia

AUC:

Area under the curve

BSG:

British Society of Gastroenterology

CEA:

Carcinoembryonic antigen

CRC:

Colorectal cancer

EWG:

Expert Working Group on FIT for Screening

f-C:

Faecal calprotectin

f-Hb:

Faecal haemoglobin concentration

FIT:

Faecal immunochemical test for haemoglobin

GI:

Gastrointestinal

Hb:

Haemoglobin

IBD:

Inflammatory bowel disease

IBS:

Irritable bowel syndrome

iFOBT:

Immunochemical faecal occult blood test

M2-PK:

The dimeric form of the pyruvate kinase isoenzyme type M2

MH:

Mucosal healing

NAA:

Non-advanced adenoma

NICE:

National Institute for Health and Care Excellence

NPV:

Negative predictive value

OBD:

Organic bowel disease

POCT:

Point-of-care test

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

SIGN:

Scottish Intercollegiate Guidelines Network

UC:

Ulcerative colitis

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Authors and Affiliations

  1. Division of Cancer, Medical Research Institute and Centre for Research into Cancer Prevention and Screening (CRiPS), Mailbox 4 Level 7, Medical Research Institute, Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland, UK

    Robert J. C. Steele

  2. Scottish Bowel Screening Research Unit, Centre for Research into Cancer Prevention and Screening (CRiPS), Mailbox 7 Level 7, Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland, UK

    Callum G. Fraser

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  1. Karolinska Institutet, Stockholm, Sweden

    Louise Olsson

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Steele, R.J.C., Fraser, C.G. (2018). Faecal Immunochemical Tests (FIT) for Haemoglobin for Timely Assessment of Patients with Symptoms of Colorectal Disease. In: Olsson, L. (eds) Timely Diagnosis of Colorectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-65286-3_3

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