Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK.
Clinical Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK.
Colorectal Dis. 2021 Jul;23(7):1639-1648. doi: 10.1111/codi.15618. Epub 2021 Mar 29.
The dramatic curtailment of endoscopy and CT colonography capacity during the coronavirus pandemic has adversely impacted timely diagnosis of colorectal cancer (CRC). We describe a rapidly implemented COVID-adapted diagnostic pathway to mitigate risk and maximize cancer diagnosis in patients referred with symptoms of suspected CRC.
The 'COVID-adapted pathway' integrated multiple quantitative faecal immunochemical tests (qFIT) to enrich for significant colorectal disease with judicious use of CT with oral contrast to detect gross pathology. Patients reporting 'high-risk' symptoms were triaged to qFIT+CT and the remainder underwent an initial qFIT to inform subsequent investigation. Demographic and clinical data were prospectively collected. Outcomes comprised cancer detection frequency.
Overall, 422 patients (median age 64 years, 220 women) were triaged using this pathway. Most (84.6%) were referred as 'urgent suspicious of cancer'. Of the 422 patients, 202 (47.9%) were triaged to CT and qFIT, 211 (50.0%) to qFIT only, eight (1.9%) to outpatient clinic and one to colonoscopy. Fifteen (3.6%) declined investigation and seven (1.7%) were deemed unfit. We detected 13 cancers (3.1%), similar to the mean cancer detection rate from all referrals in 2017-2019 (3.3%). Compared with the period 1 April-31 May in 2017-2019, we observed a 43% reduction in all primary care referrals (1071 referrals expected reducing to 609).
This COVID-adapted pathway mitigated the adverse effects on diagnostic capacity and detected cancer at the expected rate within those referred. However, the overall reduction in the number of referrals was substantial. The described risk-mitigating measures could be a useful adjunct whilst standard diagnostic services remain constrained due to the ongoing pandemic.
在冠状病毒大流行期间，内镜检查和 CT 结肠成像能力的急剧减少对结直肠癌（CRC）的及时诊断产生了不利影响。我们描述了一种快速实施的 COVID 适应诊断途径，以降低风险并最大限度地提高因疑似 CRC 症状而就诊的患者的癌症诊断率。
“COVID 适应途径”集成了多个定量粪便免疫化学测试（qFIT），以利用 CT 与口服对比来检测明显的结直肠疾病，从而对结直肠疾病进行有益的富集。报告“高风险”症状的患者被分诊到 qFIT+CT，其余患者进行初始 qFIT 以告知后续检查。前瞻性收集人口统计学和临床数据。结果包括癌症检测频率。
总体而言，有 422 名患者（中位年龄 64 岁，220 名女性）通过该途径进行了分诊。大多数（84.6%）被转诊为“紧急怀疑癌症”。在 422 名患者中，202 名（47.9%）被分诊至 CT 和 qFIT，211 名（50.0%）仅进行 qFIT，8 名（1.9%）至门诊，1 名至结肠镜检查。15 名（3.6%）拒绝检查，7 名（1.7%）被认为不适合。我们发现了 13 例癌症（3.1%），与 2017-2019 年所有转诊的平均癌症检出率相似（3.3%）。与 2017-2019 年 4 月 1 日至 5 月 31 日期间相比，我们观察到所有初级保健转诊减少了 43%（预计将从 1071 例减少到 609 例）。
这种 COVID 适应途径减轻了诊断能力的不利影响，并在转诊范围内以预期的速度检测到癌症。然而，转诊数量的总体减少是相当可观的。在所描述的风险缓解措施的辅助下，当由于持续的大流行而使标准诊断服务仍然受到限制时，这些措施可能是有用的。
