Gastroenterologist, Department of Gastroenterology, Christchurch Hospital, Canterbury.
Professor of Medicine, University of Otago/Christchurch; Clinical Director of Gastroenterology, Department of Gastroenterology, Christchurch Hospital, Christchurch.
N Z Med J. 2024 Sep 6;137(1602):102-110. doi: 10.26635/6965.6582.
Quantitative faecal haemoglobin (fHb) measurement by faecal immunochemical test (FIT) is a powerful biomarker for colorectal cancer (CRC) and is incorporated in referral, prioritisation and triage protocols for symptomatic cases in other countries. We report our use of FIT to prioritise new patient symptomatic cases referred for colorectal investigation.
Cases referred for investigation of new colorectal symptoms who were aged ≥50 years (≥40 years Māori/Pacific peoples), who would otherwise be triaged to non-urgent colonoscopy, were asked to provide a stool sample for FIT. Following FIT testing, cases were re-triaged to either urgent colonoscopy, non-urgent colonoscopy or computed tomography colonography (CTC) depending on fHb concentration (measured in micrograms haemoglobin per gram of stool [mcg/g]) and incorporating clinical judgement. At pathway initiation, cases already waiting for colonoscopy on the non-urgent new patient waiting list were approached first, and then new patient (NP) referrals for colonoscopy could be triaged to the pathway at the discretion of the triaging consultant.
Out of 739 cases, 715 (97%) returned FIT samples, and 691 cases completed colorectal investigations. Overall FIT positivity ≥10mcg/g was 17.1%. Fifteen colorectal cancers (CRC) were detected (2.2%). The sensitivity and specificity of FIT ≥10mcg/g for CRC were 80.0% (54.0-93.7%) and 84.3 (81.4-86.9%) respectively. A total of 432 cases (62.5%) completed the pathway without recourse to colonoscopy, and the median time to CRC diagnosis for NP from referral was 25 days.
FIT based prioritisation of cases referred with symptoms concerning for CRC is feasible and reduces time to CRC diagnosis.
粪便免疫化学检测（FIT）定量检测粪便血红蛋白（fHb）是结直肠癌（CRC）的有力生物标志物，并被纳入其他国家有症状病例的转诊、优先排序和分诊方案。我们报告了使用 FIT 对新出现的有症状的结直肠检查转诊病例进行优先排序的情况。
年龄≥50 岁（≥40 岁毛利/太平洋岛民）的新出现结直肠症状并接受调查的转诊病例，将被要求提供粪便样本进行 FIT 检测。FIT 检测后，根据 fHb 浓度（粪便中每克血红蛋白的微克数 [mcg/g]）和临床判断，将病例重新分诊为紧急结肠镜检查、非紧急结肠镜检查或计算机断层扫描结肠成像（CTC）。在路径启动时，首先接触已经在非紧急新患者等待名单上等待结肠镜检查的病例，然后可以根据分诊顾问的判断将新患者（NP）的结肠镜检查转诊到该路径。
在 739 例病例中，715 例（97%）返回了 FIT 样本，691 例完成了结直肠检查。总体而言，FIT 阳性≥10mcg/g 的比例为 17.1%。共发现 15 例结直肠癌（CRC）（2.2%）。FIT≥10mcg/g 对 CRC 的敏感性和特异性分别为 80.0%（54.0-93.7%）和 84.3%（81.4-86.9%）。共有 432 例（62.5%）病例无需进行结肠镜检查即可完成该路径，NP 从转诊到 CRC 诊断的中位时间为 25 天。
基于 FIT 的对有 CRC 症状的病例进行优先排序是可行的，并且可以缩短 CRC 诊断时间。
