Fraser Callum G
Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland, UK.
Surgeon. 2018 Oct;16(5):302-308. doi: 10.1016/j.surge.2018.01.004. Epub 2018 Mar 13.
Colonoscopy is a relatively scarce resource in many countries, including Scotland, and a simple investigation which would aid general practitioners in particular in decision-making as to which patients presenting with lower bowel symptoms warranted referral would be of much help. Faecal immunochemical tests for haemoglobin (FIT) have many advantageous characteristics and are now proven to be of considerable value in the timely assessment of patients with symptoms of lower bowel disease. Quantitative FIT provide numerical estimates of faecal haemoglobin concentration (f-Hb) and, at low f-Hb cut-off, FIT have high sensitivity for colorectal cancer (CRC) and could be used as a rule-in test to stimulate rapid referral, especially when symptoms are suggestive of serious bowel disease. Perhaps more importantly, a low f-Hb gives considerable reassurance that significant bowel disease (CRC + higher-risk adenoma + inflammatory bowel disease) is absent and further investigation may not be warranted: however, no test is perfect, so some cases will remain undetected using FIT alone and robust safety netting is required, possibly including watching and waiting, referral to clinics in secondary care, or a repeat FIT. Moreover, the FIT results should not be taken in isolation, but clinical impressions and the results of other investigations, probably including the full blood count, should be considered. Challenges still exist, however, and harmonisation of aspects of the available FIT analytical systems is required. Moreover, a number of seemingly valid clinical concerns remain and these require resolution through further research and reporting of studies done in real clinical practice.
在包括苏格兰在内的许多国家，结肠镜检查是一种相对稀缺的资源。一项简单的检查，尤其有助于全科医生决定哪些出现下消化道症状的患者需要转诊，这将大有帮助。粪便血红蛋白免疫化学检测（FIT）具有许多优势特性，现已证明在及时评估下消化道疾病症状患者方面具有相当大的价值。定量FIT可提供粪便血红蛋白浓度（f-Hb）的数值估计，在低f-Hb临界值时，FIT对结直肠癌（CRC）具有高灵敏度，可作为一种确诊试验以促进快速转诊，尤其是当症状提示严重肠道疾病时。也许更重要的是，低f-Hb能让人相当放心地认为不存在重大肠道疾病（CRC + 高风险腺瘤 + 炎症性肠病），可能无需进一步检查：然而，没有一种检查是完美的，所以仅使用FIT会有一些病例未被检测到，需要强有力的安全保障措施，可能包括观察等待、转诊至二级医疗诊所或重复进行FIT。此外，FIT结果不应孤立看待，而应考虑临床印象以及其他检查结果，可能包括全血细胞计数。然而，挑战依然存在，需要对现有FIT分析系统的各个方面进行统一。此外，仍存在一些看似合理的临床问题，这些问题需要通过进一步研究以及对实际临床实践中所做研究的报告来解决。
