Fraser Callum G
Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
Gastroenterol Hepatol. 2019 Apr;42(4):263-270. doi: 10.1016/j.gastrohep.2018.09.007. Epub 2018 Nov 17.
Faecal immunochemical tests for haemoglobin (FIT), as an adjunct to clinical information, assist in the triage of patients presenting in primary care with lower abdominal symptoms. Controversy remains regarding whether and which qualitative and quantitative FIT can be used, which groups of patients would benefit most from FIT, whether FIT should be done in primary and/or secondary care, and how FIT should be incorporated into diagnostic pathways. Controversy also exists as to the optimum cut-off used for referral for colonoscopy. A single sample of faeces may be sufficient. Reporting of results requires consideration. FIT provide a good rule in test for colorectal cancer and a good rule out test for significant bowel disease, but robust safety-netting is required for patients with negative results and ongoing symptoms. Risk scoring models have been developed, but their value is unclear as yet. Further evaluation of these topics is required to inform good practice.
粪便血红蛋白免疫化学检测（FIT）作为临床信息的辅助手段，有助于对基层医疗中出现下腹部症状的患者进行分流。关于是否以及使用哪种定性和定量FIT、哪些患者群体将从FIT中获益最大、FIT应在基层医疗和/或二级医疗中进行，以及FIT应如何纳入诊断路径，仍存在争议。对于结肠镜检查转诊所使用的最佳临界值也存在争议。一份粪便样本可能就足够了。结果报告需要考虑。FIT为结直肠癌提供了一个很好的阳性检测规则，为重大肠道疾病提供了一个很好的排除检测规则，但对于结果为阴性且症状持续的患者，需要强有力的安全保障措施。已经开发了风险评分模型，但其价值尚不清楚。需要对这些主题进行进一步评估，以指导良好的实践。
