Early clinical outcomes of a rapid colorectal cancer diagnosis pathway using faecal immunochemical testing in Nottingham

Chapman, Caroline J; Thomas, C; Morling, Joanne R; Simpson, J; Humes, David J; Banerjea, Ayan; Clark, S. K

Item

Early clinical outcomes of a rapid colorectal cancer diagnosis pathway using faecal immunochemical testing in Nottingham

Abstract

AIM: We introduced primary care access to faecal immunochemical testing (FIT) as a stratification tool for symptomatic patients considered to be at risk of colorectal cancer (CRC) prior to urgent referral. We aimed to evaluate clinical and pathway outcomes during the first 6 months of this novel approach., METHOD: FIT was recommended for all patients who consulted their general practitioner with lower gastrointestinal symptoms other than rectal bleeding and rectal mass. We undertook a retrospective audit of the results of FIT, related clinical outcomes and resource utilization on prospectively logged cases between November 2017 and May 2018., RESULTS: Of the 1862 FIT kits dispatched by post 91.4% were returned, with a median return time of 7 days (range 2-110 days); however, 1.3% of returned kits could not be analysed. FIT results >= 150.0 mug haemoglobin (Hb)/g faeces identified patients with a significantly higher risk of CRC (30.9% vs 1.4%, chi-square 167.1, P = 10.0 mug Hb/g faeces identified patients with significantly higher risk of significant noncancer bowel pathology (24.1% vs 4.9%, chi-square 73.6, P < 0.0001) and FIT results < 4.0 mug Hb/g faeces identified a group more likely to have non-CRC pathology (5.1% vs 2.4%, chi-square 3.9, P < 0.05). The CRC detection rate in 531 patients investigated after a FIT result of < 4.0 mug Hb/g faeces was 0.2%. In 899 investigated patients, a FIT result with a threshold of 4.0 mug Hb/g faeces had sensitivity 97.2% (85.5-99.9% CI), specificity 61.4% (58.1-64.7% CI), negative predictive value 99.8% (98.7-100.0% CI) and positive predictive value 9.5% (8.7-10.4% CI)., CONCLUSION: A symptomatic pathway incorporating FIT is feasible and appears more clinically effective than pathways based on age and symptoms alone. Copyright Colorectal Disease © 2019 The Association of Coloproctology of Great Britain and Ireland.

Author

Chapman, Caroline J
Thomas, C
Morling, Joanne R
Simpson, J
Humes, David J
Banerjea, Ayan
Clark, S. K

Date

2020

Type

Article

Subject

Colorectal neoplasms, Faecal immunochemical testing

Collections

NUH Medical Physics and Clinical Engineering

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Citation

Chapman, C., Thomas, C., Morling, J., Tangri, A., Oliver, S., Simpson, J.A., Humes, D.J. and Banerjea, A. (2020) 'Early clinical outcomes of a rapid colorectal cancer diagnosis pathway using faecal immunochemical testing in Nottingham', Colorectal Disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 22(6), pp. 679-688. doi: 10.1111/codi.14944. Clark, S.K. (2020) 'Early clinical outcomes of a rapid colorectal cancer diagnosis pathway using faecal immunochemical testing in Nottingham, Chapman et al', Colorectal Disease, 22(6), pp. 608. doi: 10.1111/codi.15101.