Academic Unit of Surgery, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
Department of Surgery, Raigmore Hospital, Inverness, UK.
Colorectal Dis. 2022 Dec;24(12):1498-1504. doi: 10.1111/codi.16240. Epub 2022 Jul 18.
The faecal immunochemical test (FIT) for faecal haemoglobin (f-Hb) helps determine the risk of colorectal cancer (CRC) and has been integrated into symptomatic referral pathways. 'Safety netting' advice includes considering referral for persistent symptoms, but no published data exists on repeated FITs. We aimed to examine the prevalence of serial FITs in primary care and CRC risk in these patients.
A multicentre, retrospective, observational study was conducted of patients with two or more consecutive f-Hb results within a year from three Scottish Health Boards which utilize FIT in primary care. Cancer registry data ensured identification of CRC cases.
Overall, 135 396 FIT results were reviewed, of which 12 359 were serial results reported within 12 months (9.1%), derived from 5761 patients. Of these, 42 (0.7%) were diagnosed with CRC. A total of 3487 (60.5%) patients had two f-Hb < 10 μg/g, 944 (16.4%) had f-Hb ≥ 10 μg/g followed by <10 μg/g, 704 (12.2%) f-Hb < 10 μg/g followed by ≥10 μg/g and 626 (10.9%) had two f-Hb ≥ 10 μg/g. The CRC rate in each group was 0.1%, 0.4%, 1.4% and 4.0%, respectively. Seven hundred and thirty four patients submitted more than two FITs within a year. The likelihood of one or more f-Hb ≥ 10 μg/g rose from 40.4% with two samples to 100% with six, while the CRC rate fell from 0.8% to 0%.
Serial FITs within a year account for 9.1% of all results in our Boards. CRC prevalence amongst symptomatic patients with serial FIT is lower than in single-FIT cohorts. Performing two FITs within a year for patients with persistent symptoms effectively acts as a safety net, while performing more than two within this timeframe is unlikely to be beneficial.
粪便免疫化学检测（FIT）用于粪便血红蛋白（f-Hb）可帮助确定结直肠癌（CRC）的风险，并已纳入有症状的转诊途径。“安全网”建议包括考虑对持续症状进行转诊，但目前尚无关于重复 FIT 的发表数据。我们旨在检查初级保健中连续 FIT 的发生率以及这些患者的 CRC 风险。
进行了一项多中心、回顾性、观察性研究，对象为来自苏格兰三个健康委员会的患者，这些委员会在初级保健中使用 FIT，他们在一年内有两个或更多连续的 f-Hb 结果。癌症登记数据确保了 CRC 病例的识别。
总共审查了 135396 个 FIT 结果，其中 12359 个是在 12 个月内报告的连续结果，来自 5761 名患者。其中，42 例（0.7%）被诊断为 CRC。共有 3487 例（60.5%）患者有两次 f-Hb<10μg/g，944 例（16.4%）有 f-Hb≥10μg/g 后<10μg/g，704 例（12.2%）f-Hb<10μg/g 后≥10μg/g，626 例（10.9%）有两次 f-Hb≥10μg/g。每组的 CRC 发生率分别为 0.1%、0.4%、1.4%和 4.0%。734 例患者在一年内提交了两次以上的 FIT。一个或多个 f-Hb≥10μg/g 的可能性从两次样本的 40.4%上升到六次样本的 100%，而 CRC 率从 0.8%下降到 0%。
一年内连续的 FIT 占我们委员会所有结果的 9.1%。在有连续 FIT 的有症状患者中，CRC 的患病率低于单次 FIT 队列。对持续有症状的患者在一年内进行两次 FIT 可有效作为安全网，而在此时间范围内进行两次以上的 FIT 可能无益。
