Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Eastern Hub, Bowel Cancer Screening Programme, Nottingham University Hospitals NHS Trust, Nottingham, UK.
BJS Open. 2021 Mar 5;5(2). doi: 10.1093/bjsopen/zraa056.
A novel pathway incorporating faecal immunochemical testing (FIT) for rapid colorectal cancer diagnosis (RCCD) was introduced in 2017. This paper reports on the service evaluation after 2 years of pathway implementation.
The RCCD protocol was based on FIT, blood results and symptoms to stratify adult patients in primary care. Two-week-wait (2WW) investigation was indicated for patients with rectal bleeding, rectal mass and faecal haemoglobin (fHb) level of 10 µg Hb/g faeces or above or 4 µg Hb/g faeces or more in the presence of anaemia, low ferritin or thrombocytosis, in all other symptom groups. Patients with 100 µg Hb/g faeces or above had expedited investigation . A retrospective audit of colorectal cancer detected between 2017 and 2019 was conducted, fHb thresholds were reviewed and critically assessed for cancer diagnoses.
In 2 years, 14788 FIT tests were dispatched with 13361 (90.4 per cent) completed returns. Overall, fHb was less than 4 µg Hb/g faeces in 9208 results (68.9 per cent), 4-9.9 µg Hb/g in 1583 (11.8 per cent), 10-99.9 µg Hb/g in 1850 (13.8 per cent) and 100 µg Hb/g faeces or above in 720 (5.4 per cent). During follow-up (median 10.4 months), 227 colorectal cancers were diagnosed. The cancer detection rate was 0.1 per cent in patients with fHb below 4 µg Hb/g faeces, 0.6 per cent in those with fHb 4-9.9 µg Hb/g faeces, 3.3 per cent for fHb 10-99.9 µg Hb/g faeces and 20.7 per cent for fHb 100 µg Hb/g faeces or above. The detection rate in the cohort with 10-19.9 µg Hb/g faeces was 1.4 per cent, below the National Institute for Health and Care Excellence threshold for urgent referral. The colorectal cancer rate in patients with fHb below 20 µg Hb/g faeces was less than 0.3 per cent.
Use of FIT to "rule out" urgent referral from primary care misses a small number of cases. The threshold for referral may be adjusted with blood results to improve stratification .
2017 年引入了一种包含粪便免疫化学检测（FIT）的快速结直肠癌诊断（RCCD）新途径。本文报告了该途径实施两年后的服务评估结果。
RCCD 方案基于 FIT、血液结果和症状，对初级保健中的成年患者进行分层。对于有直肠出血、直肠肿块和粪便血红蛋白（fHb）水平为 10μg Hb/g 粪便或以上或贫血、低铁蛋白或血小板增多症患者，fHb 水平为 4μg Hb/g 粪便或以上或以上，则进行两周等待（2WW）调查。在所有其他症状组中，fHb 水平为 100μg Hb/g 粪便或以上的患者需要进行紧急检查。对 2017 年至 2019 年期间检测到的结直肠癌进行了回顾性审核，审查并批判性评估了 fHb 阈值与癌症诊断的关系。
在两年内，共发送了 14788 次 FIT 检测，其中 13361 次（90.4%）完成了返回。总体而言，9208 份结果中 fHb 小于 4μg Hb/g 粪便（68.9%），1583 份结果中 fHb 为 4-9.9μg Hb/g（11.8%），1850 份结果中 fHb 为 10-99.9μg Hb/g（13.8%），720 份结果中 fHb 为 100μg Hb/g 粪便或以上（5.4%）。在随访期间（中位数为 10.4 个月），诊断出 227 例结直肠癌。fHb 低于 4μg Hb/g 粪便的患者癌症检出率为 0.1%，fHb 为 4-9.9μg Hb/g 粪便的患者癌症检出率为 0.6%，fHb 为 10-99.9μg Hb/g 粪便的患者癌症检出率为 3.3%，fHb 为 100μg Hb/g 粪便或以上的患者癌症检出率为 20.7%。fHb 为 10-19.9μg Hb/g 粪便的患者检出率为 1.4%，低于国家卫生与保健卓越研究所（NICE）的紧急转诊阈值。fHb 低于 20μg Hb/g 粪便的患者结直肠癌发生率低于 0.3%。
使用 FIT 来“排除”初级保健中的紧急转诊会遗漏少数病例。可以结合血液结果调整转诊阈值，以改善分层。
