SPOD3 F.I.T for Discharge? Role of Faecal Immunochemical Testing (FIT) in ruling out Primary Bowel Cancer: A review of current outcomes.

Abstract

Abstract Aim NICE recommends that a FIT <10µgHb/g may not warrant an Urgent Suspected Cancer (USC) Referral. Our primary aim was to assess outcomes at a local level for FIT <10µgHb/g. Secondary aims included whether a high FIT(>100µgHb/g) determines increased cancer risk and whether a moderate FIT(10–100µgHb/g) warrants USC inv: estigations. Methods A retrospective review of all symptomatic patients who received a FIT in a District General Hospital in North Wales between June-December 2020. These were divided into 3 groups: negative FIT(<10µgHb/g), moderate FIT(10–100µgHb/g) and high FIT(>100µgHb/g). The results of any subsequent investigations such as Endoscopies, CT Colons or CTs were recorded along with the histology results from polyps/biopsies/specimens from Endoscopy/Surgery. Simple sensitivity and negative predictive value(NPV) analyses were performed. Results A total of 722 patients returned a FIT result. 544 were negative, 106 moderate and 72 high. 2/544(0.37%) in the negative FIT group had cancer, however histology of both showed Squamous Cell Carcinoma from Anal Cancer. 3/106(2.83%) in the moderate FIT and 15/72(20.83%) in the high FIT group had cancer. Polyp histology demonstrated high-grade dysplasia in 2(2.78%) in the high, 2(1.89%) in the moderate and 0 in the negative group. FIT sensitivity of 90% and NPV of 99.62% was demonstrated. Conclusions A negative FIT can adequately exclude primary bowel cancer in symptomatic patients. Patients with high FIT could proceed “straight-to-test”, while moderate FIT may need further outpatient assessment. Inappropriate investigations and delayed diagnosis have drastic clinical and financial implications.