General Surgery Department, East Sussex Healthcare NHS Trust, Kent, United Kingdom.
General Surgery Department, East Sussex Healthcare NHS Trust, Kent, United Kingdom.
Surgeon. 2021 Feb;19(1):27-32. doi: 10.1016/j.surge.2020.02.003. Epub 2020 Mar 18.
Faecal Immunohistochemistry Testing (FIT) is recommended as an adjunct to guide referrals from Primary Care for individuals without rectal bleeding, who do not meet the suspected cancer pathway referral guidelines. It has largely replaced Faecal Occult Blood Testing.
To assess the specificity of FIT. To understand the characteristics of FIT negative cancer patients and whether they have predominantly right sided cancers. Evaluating the efficacy of FIT and Iron deficiency anaemia in combination to capture patients with colorectal cancers.
A study of 1000 symptomatic patients, undergoing FIT by Clinicians during the 'Digital rectal examination'. Inclusion criteria; all patients referred via our cancer referral pathway. FIT positivity was set at 10 μg g of faeces.
There were 7 FIT negative cancers in this cohort; 1 was a lymphoma and the other 6 were caecal adenocarcinomas. 5 were anaemic. The positive predictive value of IDA was 34% compared with 'other symptoms'; 18%. The negative predictive value of FIT was 99.05% in this cohort. Specificity for FIT was 86.9% (CI 96%).
Two separate referral pathways for IDA and FIT positive tests, would have captured all patients except 2; the lymphoma and 1 advanced caecal adenocarcinoma. FIT is an excellent triage tool prior to colonoscopy however capturing right sided disease remains a weak point. Multivariate analysis of patients in addition to IDA and FIT should improve capture of this subgroup.
粪便免疫化学测试（FIT）被推荐作为辅助手段，用于指导无直肠出血且不符合疑似癌症途径转诊标准的初级保健患者转诊。它在很大程度上取代了粪便潜血测试。
评估 FIT 的特异性。了解 FIT 阴性癌症患者的特征，以及他们是否主要患有右侧癌症。评估 FIT 和缺铁性贫血联合应用的效果，以捕获结直肠癌患者。
对 1000 名有症状的患者进行了一项研究，这些患者在“数字直肠检查”期间由临床医生进行 FIT。纳入标准：所有通过我们的癌症转诊途径转诊的患者。FIT 阳性设定为 10μg g 粪便。
在该队列中有 7 例 FIT 阴性癌症，其中 1 例为淋巴瘤，另外 6 例为盲肠腺癌。5 例贫血。IDA 的阳性预测值为 34%，而“其他症状”为 18%。该队列中 FIT 的阴性预测值为 99.05%。FIT 的特异性为 86.9%（96%CI）。
对于 IDA 和 FIT 阳性测试，有两个单独的转诊途径，可以捕获除 2 例患者（淋巴瘤和 1 例晚期盲肠腺癌）之外的所有患者。FIT 是结肠镜检查前的一种极好的分诊工具，但仍存在右侧疾病捕获不足的弱点。对除 IDA 和 FIT 之外的患者进行多变量分析，应能提高对这一亚组的捕获率。
