Waite Matthew Malcolm Andrew, Langmead Louise, Ayling Ruth M
Department of Medicine, Whipps Cross University Hospital, 9744Barts Health NHS Trust, London, UK.
Department of Gastroenterology, Royal London Hospital, 9744Barts Health NHS Trust, London, UK.
Ann Clin Biochem. 2022 May;59(3):171-177. doi: 10.1177/00045632211063458. Epub 2021 Dec 27.
NICE recommends measurement of faecal haemoglobin (f-Hb) using faecal immunochemical test (FIT) when colorectal cancer is suspected and calprotectin (f-Cal) in the context of inflammatory bowel disease, though neither is disease specific. During the COVID-19 pandemic, f-Hb has been a requirement prior to referral for endoscopy in England; f-Cal is often performed simultaneously. The aim of this study was to investigate test performance of both tests for significant bowel disease in those patients referred.
All adult patients with simultaneous measurements of f-Hb and f-Cal between April 2019 and September 2020 were included. For those referred, outcomes were determined from clinical records.
650 patients with simultaneous samples for f-Hb an f-Cal were managed in Primary Care; 319 patients were referred to hospital; SBD was found in 32 (10.0%) (CRC 5, high risk adenomas 5, IBD 22). At a cut-off of 10 μg/g for f-Hb and 200 μg/g for f-Cal, the sensitivity, specificity and negative predictive value for diagnosis of SBD were 84.4%, 58.2% and 96.7% and 68.8%, 89.6% and 95.7%, respectively. Performance of both tests would have enabled diagnosis of two more cases of significant, but non-malignant, bowel disease but required over 4% more referrals for investigation.
Use of FIT has become established to assist prioritisation of patients for referral from Primary Care. Whilst introduced specifically for CRC, FIT performs well as a rule out for IBD in Primary Care and the use of f-Cal is not required.
英国国家卫生与临床优化研究所（NICE）建议，在怀疑患有结直肠癌时，使用粪便免疫化学检测（FIT）来测量粪便血红蛋白（f-Hb）；在炎症性肠病的情况下，测量钙卫蛋白（f-Cal），不过这两种检测都不是疾病特异性的。在2019冠状病毒病（COVID-19）大流行期间，在英格兰，进行内镜检查转诊前需要检测f-Hb；f-Cal通常也会同时检测。本研究的目的是调查这两种检测方法对这些转诊患者中重大肠道疾病的检测性能。
纳入2019年4月至2020年9月期间同时检测f-Hb和f-Cal的所有成年患者。对于转诊患者，根据临床记录确定结果。
基层医疗中对650例同时采集f-Hb和f-Cal样本的患者进行了管理；319例患者被转诊至医院；发现32例（10.0%）患有重大肠道疾病（结直肠癌5例、高危腺瘤5例、炎症性肠病22例）。f-Hb临界值为10μg/g、f-Cal临界值为200μg/g时，诊断重大肠道疾病的灵敏度、特异度和阴性预测值分别为84.4%、58.2%和96.7%，以及68.8%、89.6%和95.7%。两种检测方法的应用本可以诊断出另外两例重大但非恶性的肠道疾病病例，但需要多转诊超过4%的患者进行检查。
FIT的应用已被确立，以帮助基层医疗中患者转诊的优先排序。虽然FIT是专门为结直肠癌引入的，但在基层医疗中作为排除炎症性肠病的检测方法表现良好，无需使用f-Cal。
