Abstract
BackgroundThe faecal immunochemical test (FIT) has proven utility for colorectal cancer detection in symptomatic patients. However, most patients with a raised faecal haemoglobin (f-Hb) do not have colorectal cancer. We investigated alternative diagnoses and demographics associated with a raised f-Hb in symptomatic patients.MethodsA retrospective, observational study was performed of patients with FIT submitted between August 2018 to January 2019 in NHS Greater Glasgow and Clyde followed by colonoscopy. Colonoscopy/pathology reports were searched for alternative diagnoses. Covariables were compared using the χ 2 test. Multivariate binary logistic regression identified independent predictors of a raised f-Hb.Results1272 patients were included. In addition to colorectal cancer (odds ratio (OR), 9.27 (95% confidence interval (CI): 3.61–23.83; p < 0.001)), older age (OR, 1.52 (95% CI: 1.00–2.32; p = 0.05)), deprivation (OR, 1.54 (95% CI: 1.21–1.94; p < 0.001)), oral anticoagulants (OR, 1.78 (95% CI: 1.01–3.15; p = 0.046)), rectal bleeding (OR, 1.47 (95% CI: 1.15–1.88; p = 0.002)), advanced adenoma (OR, 7.52 (95% CI: 3.90–14.49; p < 0.001)), non-advanced polyps (OR, 1.78 (95% CI: 1.33–2.38; p < 0.001)) and inflammatory bowel disease (IBD) (OR, 4.19 (95% CI: 2.17–8.07; p < 0.001)) independently predicted raised f-Hb. Deprivation (Scottish Index of Multiple Deprivation (SIMD) 1-2: OR, 2.13 (95% CI: 1.38–3.29; p = 0.001)) independently predicted a raised f-Hb in patients with no pathology found at colonoscopy.ConclusionsAn elevated f-Hb is independently associated with older age, deprivation, anticoagulants, rectal bleeding, advanced adenoma, non-advanced polyps and IBD in symptomatic patients. Deprivation is associated with a raised f-Hb in the absence of pathology. This must be considered when utilising FIT in symptomatic patients.
Highlights
The faecal immunochemical test (FIT) has proven utility for colorectal cancer detection in symptomatic patients, sensitivity and specificity reportedly ranging from 85% to 100% and56% to 91% respectively at a threshold of ≥10 μg Hb/g faeces[1,2,3,4,5,6,7,8]
The National Institute for th Health and Care Excellence (NICE) recommend FIT be used in patients with high-risk symptoms that may trigger an urgent suspected cancer referral (NG12)[9] and in those with we vipet
Mrsio dVe associated with older age, male sex, deprivation, aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), oral anticoagulants, proton pump inhibitors (PPIs), antibiotics and smoking[22,23,24,25] and false positivity has been related to younger age, female sex, smoking, high
Summary
The faecal immunochemical test (FIT) has proven utility for colorectal cancer detection in symptomatic patients, sensitivity and specificity reportedly ranging from 85% to 100% and56% to 91% respectively at a threshold of ≥10 μg Hb/g faeces[1,2,3,4,5,6,7,8]. The faecal immunochemical test (FIT) has proven utility for colorectal cancer detection in symptomatic patients, sensitivity and specificity reportedly ranging from 85% to 100% and. The National Institute for th Health and Care Excellence (NICE) recommend FIT be used in patients with high-risk symptoms that may trigger an urgent suspected cancer referral (NG12)[9] and in those with we vipet or lower risk symptoms (DG30)[10]. A raised f-Hb in symptomatic patients has been correlated advanced adenomas and inflammatory bowel disease[12,13,14,15]. The faecal immunochemical test (FIT) has proven utility for colorectal cancer detection in symptomatic patients. Most patients with a raised faecal haemoglobin (f-Hb) do not th have colorectal cancer. We investigated alternative diagnoses and demographics associated we vipet or with a raised f-Hb in symptomatic patients
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More From: Annals of Clinical Biochemistry: International Journal of Laboratory Medicine
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