The repeat FIT (RFIT) study: Does repeating faecal immunochemical tests provide reassurance and improve colorectal cancer detection?
FIT
colorectal cancer
detection
faecal immunochemical test
symptomatic
Journal
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
ISSN: 1463-1318
Titre abrégé: Colorectal Dis
Pays: England
ID NLM: 100883611
Informations de publication
Date de publication:
13 Aug 2024
13 Aug 2024
Historique:
revised:
22
07
2024
received:
12
02
2024
accepted:
23
07
2024
medline:
13
8
2024
pubmed:
13
8
2024
entrez:
13
8
2024
Statut:
aheadofprint
Résumé
Faecal immunochemical tests (FIT) are highly sensitive for colorectal cancer (CRC) detection. Little evidence exists regarding repeat FIT. The repeat FIT (RFIT) study aimed to determine whether second and third FIT provide reassurance and improve CRC or significant bowel disease (SBD) identification. This was a prospective observational study. Patients recruited from urgent referrals returned three FIT and underwent colonoscopy. Chi-square tests compared categorical data. Diagnostic accuracy variables (sensitivity/specificity/positive predictive value [PPV]/negative predictive value [NPV]) were calculated for one, two and three FIT (95% CI). Three negative FIT (<10 μg Hb/g of faeces [μg/g]) groups (one, two, three) were compared with positive groups (one or more FIT ≥10 μg/g). CRC and SBD detection rates were compared by strategy. A total of 460 patients (mean age: 66.8 years, 233 males and 227 females, 23 CRC, 80 SBD) were included in the study. For one, two and three negative FIT, CRC sensitivity remained static (95.7%); specificity (44.6%, 40.7% and 38.4%) and NPV decreased (99.5%, 99.4% and 99.4%). For SBD, sensitivity increased (78.8%, 83.8% and 86.3%), specificity decreased (47.4%, 43.7% and 41.6%) and NPV increased (91.4%, 92.7% and 93.5%). In one, two and three positive FIT groups, CRC detection was 8.3%,16.1% and 20.9%. CRC mean FIT was 150 μg/g, <6 μg/g for benign pathology. One or more negative FIT increases the sensitivity for CRC/SBD. Repeating FIT provides greater differentiation of patients with and without CRC/SBD compared to single FIT but is associated with decreased specificity and PPV. Multiple negative FIT may offer reassurance; however, application of repeating FIT may be restricted given the associated increase in investigations S1.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Guts Fighting Bowel Cancer, www.gutsfbc.co.uk
Informations de copyright
© 2024 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.
Références
NICE. NICE Diagnostics guidance [DG56] Quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care [Internet]. 2023. Available from: www.nice.org.uk/guidance/dg56
Thompson M, O'Leary D, Heath I, Wood LF, Ellis B, Flashman K, et al. Have large increases in fast track referrals improved bowel cancer outcomes in UK? BMJ. 2020;371:m3273.
Monahan KJ, Davies MM, Abulafi M, Banerjea A, Nicholson BD, Arasaradnam R, et al. Faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC): a joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG). Gut. 2022;71(10):1939–1962.
Caron M, Lamarre G, Grégoire P, Simonyan D, Laflamme N. The fecal immunochemical test (fit): selected aspects regarding its effectiveness for colorectal cancer screening in Quebec City. Prev Med Rep. 2018;12:6–11.
Imperiale TF, Gruber RN, Stump TE, Emmett TW, Monahan PO. Performance characteristics of fecal immunochemical tests for colorectal cancer and advanced adenomatous polyps: a systematic review and meta‐analysis. Ann Intern Med. 2019;170(5):319–329.
Rutter MD, East J, Rees CJ, Cripps N, Docherty J, Dolwani S, et al. British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post‐polypectomy and post‐colorectal cancer resection surveillance guidelines. Gut. 2019;204:201–223.
Decker KM, Singh H. Reducing inequities in colorectal cancer screening in North America. J Carcinog. 2014;13:12.
D'Souza N, Delisle TG, Chen M, Benton S, Abulafi M. Faecal immunochemical test is superior to symptoms in predicting pathology in patients with suspected colorectal cancer symptoms referred on a 2WW pathway: a diagnostic accuracy study. Gut. 2021;70(6):1130–1138.
Mowat C, Digby J, Strachan JA, McCann RK, Carey FA, Fraser CG, et al. Faecal haemoglobin concentration thresholds for reassurance and urgent investigation for colorectal cancer based on a faecal immunochemical test in symptomatic patients in primary care. Ann Clin Biochem. 2021;58(3):211–219.
Farkas NG, Fraser CG, Maclean W, Jourdan I, Rockall T, Benton SC. Replicate and repeat faecal immunochemical tests in symptomatic patients: a systematic review. Ann Clin Biochem. 2023;60(1):27–36.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–1499.
NICE. Suspected cancer: recognition and referral NICE guideline [NG12] [Internet]. 2021. Available from: www.nice.org.uk/guidance/ng12
Areia M, Fuccio L, Hassan C, Dekker E, Dias‐Pereira A, Dinis‐Ribeiro M. Cost‐utility analysis of colonoscopy or faecal immunochemical test for population‐based organised colorectal cancer screening. United European Gastroenterol J. 2019;7(1):105–113.
Hunt N, Rao C, Logan R, Chandrabalan V, Oakey J, Ainsworth C, et al. A cohort study of duplicate faecal immunochemical testing in patients at risk of colorectal cancer from north‐West England. BMJ Open. 2022;12(4):e059940.
Gerrard AD, Maeda Y, Miller J, Gunn F, Theodoratou E, Noble C, et al. Double faecal immunochemical testing in patients with symptoms suspicious of colorectal cancer. Br J Surg. 2023;110(4):471–480.
Johnstone MS, MacLeod C, Digby J, Al‐Azzawi Y, Pang G, Watson AJM, et al. Prevalence of repeat faecal immunochemical testing in symptomatic patients attending primary care. Color Dis. 2022;24(12):1498–1504.
Maclean W, Whyte MB, Farkas N, Benton SC, Rockall T, Jourdan I. Patient‐reported outcome measures show FIT as an acceptable investigation to rule out colorectal cancer in the two‐week wait cohort. Ann R Coll Surg Engl. 2023;105(4):336–341.
Chapman C, Bunce J, Oliver S, Ng O, Tangri A, Rogers R, et al. Service evaluation of faecal immunochemical testing and anaemia for risk stratification in the 2‐week‐wait pathway for colorectal cancer. BJS Open. 2019;3(3):395–402.
Cunin L, Khan AA, Ibrahim M, Lango A, Klimovskij M, Harshen R. FIT negative cancers: a right‐sided problem? Implications for screening and whether iron deficiency anaemia has a role to play. Surgeon. 2021;19(1):27–32.