Faecal immunochemical tests safely enhance rational use of resources during the assessment of suspected symptomatic colorectal cancer in primary care: systematic review and meta-analysis
| Autor: | Noel Pin-Vieito, Joaquín Cubiella, Cristina Sánchez-Gómez, Coral Tejido-Sandoval, Natalia de Vicente-Bielza |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty Colorectal cancer MEDLINE Colonoscopy Primary care Rational use Sensitivity and Specificity 03 medical and health sciences Feces Hemoglobins 0302 clinical medicine Internal medicine medicine Humans Early Detection of Cancer medicine.diagnostic_test Primary Health Care business.industry Gastroenterology medicine.disease Triage Systematic review 030220 oncology & carcinogenesis Meta-analysis Occult Blood 030211 gastroenterology & hepatology business Colorectal Neoplasms |
| Zdroj: | Gut. 71(5) |
| ISSN: | 1468-3288 |
| Popis: | ObjectiveImplementation of faecal immunochemical tests (FIT) as a triage test in primary healthcare may improve the efficiency of referrals without missing cases of colorectal cancer (CRC). We aim to summarise the performance characteristics of FITs for CRC in symptomatic patients presenting to primary healthcare.DesignWe performed a systematic literature review of Medline and EMBASE databases from May 2018 to November 2020. Previous related systematic searches were also adapted to this aim and completed with reference screening. We identified studies performed on adult patients consulting for abdominal symptoms in primary care which reported data such that the FIT diagnostic performance parameters for CRC could be obtained. Bivariate models were used to synthesise available evidence. Meta-regression analysis was performed to evaluate the causes of heterogeneity.ResultsTwenty-three studies (69 536 participants) were included (CRC prevalence 0.3%–6.2%). Six studies (n=34 691) assessed FIT as rule in test (threshold of ≥150 µg Hb/g faeces) showing a sensitivity of 64.1% (95% CI 57.8% to 69.9%) and a specificity of 95.0% (95% CI 91.2% to 97.2%). A threshold of 10 µg/g (15 studies; n=48 872) resulted in a sensitivity of 87.2% (95% CI 81.0% to 91.6%) and a specificity of 84.4% (95% CI 79.4% to 88.3%) for CRC. At a 20 µg Hb/g faeces threshold (five studies; n=24 187) less than one additional CRC would be missed per 1000 patients investigated compared with 10 µg Hb/g faeces threshold (CRC prevalence 2%).ConclusionFIT is the test of choice to evaluate patients with new-onset lower gastrointestinal symptoms in primary healthcare. |
| Databáze: | OpenAIRE |
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