| Autor: |
Catherine Neck, John Renninson, Alex Atkins, S. Bailey, Gary A. Abel, Rachel Byford, Sarah-Jane Davies, Timothy J. McDonald, Joe Mays, Sarah Warren, Paul G. Thomas, Willie Hamilton, Fiona M Walter, Jon Miller |
| Jazyk: |
angličtina |
| Rok vydání: |
2020 |
| Předmět: |
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| DOI: |
10.1101/2020.08.21.20173534 |
| Popis: |
ObjectivesTo evaluate the faecal immunochemical test (FIT) for primary care clinicians to triage patients with low-risk symptoms of possible colorectal cancer, and to estimate its diagnostic performance.DesignService delivery evaluation.SettingAll primary and secondary care providers in the South West of England, approximate population 4 million.Participants3890 patients aged ≥50 years presenting in primary care with low-risk symptoms of colorectal cancer, following NICE NG12 and DG30, with a FIT (HM-JACKarc assay) analysed from 01/06/2018 to 31/12/2018.Main outcome measuresDiagnosis of colorectal cancer.Results618 (15.9%) patients tested positive at a threshold of 10μg Hb/g faeces (median 36μg Hb/g faeces (IQR 17 to 149)); 458 (74.1%) of these had an urgent referral to specialist lower gastrointestinal (GI) services within three months. 43 were diagnosed with colorectal cancer within 12 months. 3272 patients tested negative; 324 (9.9%) were referred on an urgent lower GI pathway in secondary care within three months. 8 were diagnosed with colorectal cancer within 12 months. The positive predictive value of FIT for colorectal cancer in the low-risk symptomatic population was 7.0% (95% CI 5.1% to 9.3%) and the negative predictive value was 99.8% (CI 99.5% to 99.9%). Sensitivity was 84.3% (CI 71.4% to 93.0%),and specificity 85.0% (CI 83.8% to 86.1%). The area under the ROC curve was 0.92 (CI 0.86 to 0.96). A threshold of 37μg Hb/g faeces would identify patients with an individual 3% risk of cancer.ConclusionsFIT performs exceptionally well to triage patients with low-risk symptoms of colorectal cancer in primary care. The threshold value of 10μg Hb/g faeces represents a risk of cancer below 3% used in current NICE guidance; however, this lower value may be appropriate to meet the national aspiration of improving cancer diagnostics. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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