Byun Ui Ho, Anderson Neil, Upton Arlo, Frankish Paul
Department of Surgery, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand; and Corresponding author. Email:
Coast to Coast Healthcare, 220 Rodney St, Wellsford, Auckland, New Zealand.
J Prim Health Care. 2019 Sep;11(3):259-264. doi: 10.1071/HC18068.
INTRODUCTION The faecal immunochemical test (FIT) detects small quantities of human haemoglobin in faeces. This test has increasingly become the screening tool of choice in bowel cancer screening programmes worldwide, including New Zealand's upcoming national screening programme. AIM This study audited the appropriate use of faecal immunochemical tests (FIT) in general practice as current recommendations discourage the use of FIT outside the National Bowel Screening Programme. METHODS Data on all FIT requested by a multiclinic general practice serving 16000 patients from May 2017 to May 2018 were extracted from clinical records. Patient characteristics, results of tests, clinical rationale for the test, number of referrals and results and the completeness of clinical evaluation were recorded. RESULTS In all, 184 patients received an FIT, with 13 (7.1%) positive and 145 (78.8%) negative tests, and 26 (14.1%) tests declined by the laboratory. Nine patients (69.2%) with a positive FIT, 12 patients (8.1%) with a negative FIT and one patient (3.8%) with a declined test were referred to gastroenterology services. Seven colorectal cancers were detected, all in patients with a positive FIT who were aged between 67 and 91 years. FIT was requested most for changes in bowel habit (53%) and blood in stool (15%); 10% of tests were ordered for reassurance and 9% did not record an indication for the test. Two general practitioners (of 17 in the practice) accounted for over half of all tests requested. CONCLUSIONS Because FIT is only a screening tool for colorectal cancer, direct referral is recommended for symptomatic patients. Although cancers were detected only in patients with positive FITs, these patients would have qualified for direct referral for definitive investigation, and a referral was made concurrently. Awaiting test results may also delay necessary referrals and a negative FIT may produce false reassurance.
引言 粪便免疫化学检测（FIT）可检测粪便中少量的人血红蛋白。该检测已日益成为全球范围内包括新西兰即将开展的全国筛查计划在内的肠癌筛查项目中的首选筛查工具。目的 本研究审核了全科医疗中粪便免疫化学检测（FIT）的合理使用情况，因为当前建议不鼓励在国家肠道筛查计划之外使用FIT。方法 从临床记录中提取了一家为16000名患者服务的多诊所全科医疗在2017年5月至2018年5月期间所申请的所有FIT数据。记录了患者特征、检测结果、检测的临床理由、转诊次数及结果以及临床评估的完整性。结果 共有184名患者接受了FIT检测，其中13例（7.1%）检测结果为阳性，145例（78.8%）为阴性，26例（14.1%）检测被实验室拒收。9例（69.2%）FIT检测阳性患者、12例（8.1%）FIT检测阴性患者和1例（3.8%）检测被拒收患者被转诊至胃肠病科。共检测出7例结直肠癌，均为FIT检测阳性患者，年龄在67至91岁之间。申请FIT检测最常见的原因是排便习惯改变（53%）和便血（15%）；10%的检测是为了让患者安心，9%的检测未记录检测指征。该诊所17名全科医生中有2名医生申请的检测占所有检测的一半以上。结论 由于FIT只是结直肠癌的筛查工具，建议对有症状的患者直接转诊。尽管仅在FIT检测阳性的患者中检测出癌症，但这些患者本就有资格直接转诊进行确定性检查，且已同时进行了转诊。等待检测结果可能也会延迟必要的转诊，而FIT检测阴性可能会给患者带来错误的安心感。
