Low faecal haemoglobin concentration potentially rules out significant colorectal disease

McDonald, Paul C.; Digby, Jayne; Innes, Caron; Strachan, J; Carey, Francis A.; Steele, Robert; Fraser, Callum G.

doi:10.1111/codi.12087

Cited by 73 publications

(107 citation statements)

References 28 publications

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“…FIT has recently been evaluated for CRC diagnosis in symptomatic patients and compared with available referral criteria. The available studies show that FIT has a high diagnostic accuracy for CRC detection and our results confirm these findings [8, 15–18]. In fact, the COLONPREDICT score is the first FIT-based CRC prediction model in this setting.…”

Section: Discussionsupporting

confidence: 87%

Development and external validation of a faecal immunochemical test-based prediction model for colorectal cancer detection in symptomatic patients

Cubiella

Vega

Salve

et al. 2016

BMC Med

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BackgroundRisk prediction models for colorectal cancer (CRC) detection in symptomatic patients based on available biomarkers may improve CRC diagnosis. Our aim was to develop, compare with the NICE referral criteria and externally validate a CRC prediction model, COLONPREDICT, based on clinical and laboratory variables.MethodsThis prospective cross-sectional study included consecutive patients with gastrointestinal symptoms referred for colonoscopy between March 2012 and September 2013 in a derivation cohort and between March 2014 and March 2015 in a validation cohort. In the derivation cohort, we assessed symptoms and the NICE referral criteria, and determined levels of faecal haemoglobin and calprotectin, blood haemoglobin, and serum carcinoembryonic antigen before performing an anorectal examination and a colonoscopy. A multivariate logistic regression analysis was used to develop the model with diagnostic accuracy with CRC detection as the main outcome.ResultsWe included 1572 patients in the derivation cohort and 1481 in the validation cohorts, with a 13.6 % and 9.1 % CRC prevalence respectively. The final prediction model included 11 variables: age (years) (odds ratio [OR] 1.04, 95 % confidence interval [CI] 1.02–1.06), male gender (OR 2.2, 95 % CI 1.5–3.4), faecal haemoglobin ≥20 μg/g (OR 17.0, 95 % CI 10.0–28.6), blood haemoglobin <10 g/dL (OR 4.8, 95 % CI 2.2–10.3), blood haemoglobin 10–12 g/dL (OR 1.8, 95 % CI 1.1–3.0), carcinoembryonic antigen ≥3 ng/mL (OR 4.5, 95 % CI 3.0–6.8), acetylsalicylic acid treatment (OR 0.4, 95 % CI 0.2–0.7), previous colonoscopy (OR 0.1, 95 % CI 0.06–0.2), rectal mass (OR 14.8, 95 % CI 5.3–41.0), benign anorectal lesion (OR 0.3, 95 % CI 0.2–0.4), rectal bleeding (OR 2.2, 95 % CI 1.4–3.4) and change in bowel habit (OR 1.7, 95 % CI 1.1–2.5). The area under the curve (AUC) was 0.92 (95 % CI 0.91–0.94), higher than the NICE referral criteria (AUC 0.59, 95 % CI 0.55–0.63; p < 0.001). On the basis of the thresholds with 90 % (5.6) and 99 % (3.5) sensitivity, we divided the derivation cohort into three risk groups for CRC detection: high (30.9 % of the cohort, positive predictive value [PPV] 40.7 %, 95 % CI 36.7–45.9 %), intermediate (29.5 %, PPV 4.4 %, 95 % CI 2.8–6.8 %) and low (39.5 %, PPV 0.2 %, 95 % CI 0.0–1.1 %). The discriminatory ability was equivalent in the validation cohort (AUC 0.92, 95 % CI 0.90–0.94; p = 0.7).ConclusionsCOLONPREDICT is a highly accurate prediction model for CRC detection.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0668-5) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 87%

Development and external validation of a faecal immunochemical test-based prediction model for colorectal cancer detection in symptomatic patients

Cubiella

Vega

Salve

et al. 2016

BMC Med

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“…Previous studies suggest that hemoglobin may remain in sufficient quantities to be detected even after heat exposure, 21,22 but may need a lower positivity threshold. This may also account for the relatively small variation in sensitivity, consistent with previous studies suggesting that cancerous lesions produce larger amounts of occult blood than nonmalignant sources of bleeding, 23,24 but such hypotheses require further study.…”

Section: Discussionsupporting

confidence: 83%

Fecal Immunochemical Test (FIT) for Colon Cancer Screening: Variable Performance with Ambient Temperature

Doubeni

Jensen

Fedewa

et al. 2016

The Journal of the American Board of Family Medicine

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Introduction Fecal immunochemical tests (FITs) are widely used in colorectal cancer (CRC) screening, but hemoglobin degradation, due to exposure of the collected sample to high temperatures, could reduce test sensitivity. We examined the relation of ambient temperature exposure with FIT positivity rate and sensitivity. Methods This was a retrospective cohort study of patients 50 to 75 years in Kaiser Permanente Northern California’s CRC screening program, which began mailing FIT kits annually to screen-eligible members in 2007. Primary outcomes were FIT positivity rate and sensitivity to detect CRC. Predictors were month, season, and daily ambient temperatures of test result dates based on US National Oceanic and Atmospheric Administration data. Results Patients (n =472,542) completed 1,141,162 FITs. Weekly test positivity rate ranged from 2.6% to 8.0% (median, 4.4%) and varied significantly by month (June/July vs December/January rate ratio [RR] =0.79, 95% confidence interval [CI], 0.76 to 0.83) and season. FIT sensitivity was lower in June/July (74.5%; 95% CI, 72.5 to 76.6) than January/December (78.9%; 95% CI, 77.0 to 80.7). Conclusions FITs completed during high ambient temperatures had lower positivity rates and lower sensitivity. Changing kit design, specimen transportation practices, or avoiding periods of high ambient temperatures may help optimize FIT performance, but may also increase testing complexity and reduce patient adherence, requiring careful study.

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“…Here, iFOBT before referral seems unnecessary. In patients with symptoms with low risk of CRC, iFOBT could be of value to select patients for endoscopy [23]. However, one should be aware that iFOBTs in our study were negative in approximately every sixth case of CRC without rectal bleeding.…”

Section: Discussionmentioning

confidence: 77%

Immunochemical faecal occult blood tests in primary care and the risk of delay in the diagnosis of colorectal cancer

Högberg

Karling

Rutegård

et al. 2013

Scandinavian Journal of Primary Health Care

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ObjectiveTo evaluate the value, risks, and shortcomings of immunochemical faecal occult blood tests (iFOBTs) in the diagnosis of colorectal cancer (CRC) and adenomas with high-grade dysplasia (HGD) in patients initially presenting to primary care.DesignA retrospective population-based study.Setting and subjectsAll 495 cases of CRC and adenomas with HGD diagnosed in the county of Jämtland, Sweden from 2005 to 2009.ResultsOf 495 patients 323 (65%) initially presented to primary care. IFOBTs were performed in 215 of 323 (67%) patients. The sensitivity of iFOBT for CRC and adenomas with HGD was 88% (83% when patients with a history of rectal bleeding were excluded). Of 34 patients with anaemia found en passant, 10 had negative iFOBTs. Time to diagnosis was longer for patients with negative iFOBTs (p < 0.0005).ConclusionIFOBT might be helpful in selecting which patients to refer for colonoscopy. However, iFOBT has a limited sensitivity as a diagnostic test for CRC and adenomas with HGD. Relying only on iFOBT for colonoscopy referral could delay diagnosis, especially for patients with anaemia found en passant.

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Low faecal haemoglobin concentration potentially rules out significant colorectal disease

Abstract: Faecal Hb concentration measurements have considerable potential to contribute to reducing unnecessary endoscopy for the majority of symptomatic patients.

Cited by 73 publications

References 28 publications

Development and external validation of a faecal immunochemical test-based prediction model for colorectal cancer detection in symptomatic patients

Development and external validation of a faecal immunochemical test-based prediction model for colorectal cancer detection in symptomatic patients

Fecal Immunochemical Test (FIT) for Colon Cancer Screening: Variable Performance with Ambient Temperature

Immunochemical faecal occult blood tests in primary care and the risk of delay in the diagnosis of colorectal cancer

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