Making colorectal cancer screening FITTER for purpose with quantitative faecal immunochemical tests for haemoglobin (FIT)

Fraser, Callum G.; Halloran, Stephen P; Allison, James E.; Young, Graeme P.

doi:10.1515/cclm-2013-0408

Cited by 16 publications

(15 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A major issue is that gFOBTs have a subjective and evanescent end point not readable, let alone quantifiable, using automated instrumentation and therefore not suited to high-throughput screening programs. Professional quality assurance programs are minimal [ 29 ], and problems in variation in reading of gFOBT among laboratory staff have been well known for decades [ 30 , 31 ].…”

Section: Introductionmentioning

confidence: 99%

Advances in Fecal Occult Blood Tests: The FIT Revolution

et al. 2014

Self Cite

View full text Add to dashboard Cite

There is a wide choice of fecal occult blood tests (FOBTs) for colorectal cancer screening. Goal: To highlight the issues applicable when choosing a FOBT, in particular which FOBT is best suited to the range of screening scenarios. Four scenarios characterize the constraints and expectations of screening programs: (1) limited colonoscopy resource with a need to constrain test positivity rate; (2) a priority for maximum colorectal neoplasia detection with little need to constrain colonoscopy workload; (3) an “adequate” endoscopy resource that allows balancing the benefits of detection with the burden of service provision; and (4) a need to maximize participation in screening. Guaiac-based FOBTs (gFOBTs) have significant deficiencies, and fecal immunochemical tests (FITs) for hemoglobin have emerged as better tests. gFOBTs are not sensitive to small bleeds, specificity can be affected by diet or drugs, participant acceptance can be low, laboratory quality control opportunities are limited, and they have a fixed hemoglobin concentration cutoff determining positivity. FITs are analytically more specific, capable of quantitation and hence provide flexibility to adjust cutoff concentration for positivity and the balance between sensitivity and specificity. FITs are clinically more sensitive for cancers and advanced adenomas, and because they are easier to use, acceptance rates are high. Conclusions: FOBT must be chosen carefully to meet the needs of the applicable screening scenario. Quantitative FIT can be adjusted to suit Scenarios 1, 2 and 3, and for each, they are the test of choice. FITs are superior to gFOBT for Scenario 4 and gFOBT is only suitable for Scenario 1.

show abstract

Section: Introductionmentioning

confidence: 99%

Advances in Fecal Occult Blood Tests: The FIT Revolution

et al. 2014

Self Cite

View full text Add to dashboard Cite

show abstract

“…FIT currently use different analytical materials, report results unique to the individual device and have no consensus method of measuring and reporting sample collection mass or test stability. To aid the difficult process of selecting a test kit and cut-off concentration appropriate to individual screening programmes the World Endoscopy Organization formed an Expert Working Group ‘FIT for Screening’ in 2011 to identify and promote standardisation of FIT [16], [20], [21], [33], [34], [35]. …”

Section: Discussionmentioning

confidence: 99%

Tests detecting biomarkers for screening of colorectal cancer: What is on the horizon?

Phalguni

Seaman

Routh

et al. 2015

GMS Health Technology Assessment; 11:Doc01; ISSN 1861-8863

View full text Add to dashboard Cite

“…Unfortunately, very few publications actually follow the EWG guidelines on standards for FIT evaluation reporting guidelines, namely the FITTER guidelines [21,22].…”

Section: The State Of the Art Of Faecal Haemoglobin Concentration Examentioning

confidence: 99%

“…• Proposal 5: Such academic reports should follow the FITTER guidelines [21,22] and inform on examination performance characteristics achieved, particularly at or near the LoD.…”

Section: Proposals For Reporting F-hb Data At Low Concentrationsmentioning

confidence: 99%

Detection capability of quantitative faecal immunochemical tests for haemoglobin (FIT) and reporting of low faecal haemoglobin concentrations

Fraser

Benton

2019

Clinical Chemistry and Laboratory Medicine (CCLM)

Self Cite

View full text Add to dashboard Cite

Faecal immunochemical tests for haemoglobin (FIT) are widely used in asymptomatic population screening for colorectal (bowel) cancer. FIT are also used to assist with the assessment of patients presenting with lower abdominal symptoms. Quantitative FIT allow the generation of numerical estimates of faecal haemoglobin (f-Hb) concentrations. There is now great interest in "low" f-Hb concentrations in these clinical settings: in consequence, knowledge of the detection capability is very important for f-Hb concentration examinations. There are a number of current problems associated with the reporting of low f-Hb concentrations and wide misunderstanding of the metrological aspects of examinations of f-Hb at low concentrations. These would be solved if the detectability characteristics of f-Hb concentration examinations, namely, the limit of blank (LoB), limit of detection (LoD) and limit of quantitation (LoQ), were generated, validated and used in reporting systems exactly as recommended in the EP17-A2 guideline of the Clinical Laboratory Standards Institute. LoB and LoD are statistical concepts, but the LoQ depends on definition of analytical performance specifications (APS). In this Opinion Paper proposals for interim APS are made, based on the current state of the art achieved with examinations of faecal samples. It is proposed that LoQ is determined at an examination imprecision of CV≤10% using faecal samples naturally positive for Hb rather than faeces spiked with haemolysate. Detailed proposals for reporting f-Hb data at low concentrations are also made.

show abstract

Making colorectal cancer screening FITTER for purpose with quantitative faecal immunochemical tests for haemoglobin (FIT)

Cited by 16 publications

References 13 publications

Advances in Fecal Occult Blood Tests: The FIT Revolution

Advances in Fecal Occult Blood Tests: The FIT Revolution

Tests detecting biomarkers for screening of colorectal cancer: What is on the horizon?

Detection capability of quantitative faecal immunochemical tests for haemoglobin (FIT) and reporting of low faecal haemoglobin concentrations

Contact Info

Product

Resources

About