期刊
COLORECTAL DISEASE
卷 23, 期 10, 页码 2539-2549出版社
WILEY
DOI: 10.1111/codi.15786
关键词
colonoscopy; colorectal neoplasms; diagnostic accuracy; faecal immunochemical test; FIT
资金
- NHS England
- National Institute for Health Research Clinical Research Network Portfolio
- Croydon University Hospital
Detectable fecal hemoglobin on FIT in symptomatic younger patients may indicate referral for investigation of colorectal cancer and serious bowel disease. The sensitivity of FIT for younger patients aged <50 was 87.5%, 81.3%, and 68.8% at different fecal hemoglobin cut-offs, with a high negative predictive value for colorectal cancer at all cut-offs.
Aim Detection of early onset colorectal cancer is challenging, and remains a rare diagnosis amongst younger people with gastrointestinal symptoms. We investigated whether faecal immunochemical testing (FIT) could identify younger patients at higher risk of colorectal cancer or serious bowel disease including colorectal cancer, inflammatory bowel disease or advanced adenomas. Methods A subgroup analysis was performed of symptomatic patients under 50 years of age (<50) from the NICE FIT study, a multicentre, prospective diagnostic accuracy study of FIT conducted between October 2017 and December 2019. The diagnostic accuracy of FIT for colorectal cancer and serious bowel disease was investigated in younger patients at different faecal haemoglobin (f-Hb) cut-offs of 2, 10 and 150 mu g blood/g faeces (mu g/g). Results Early onset colorectal cancer was diagnosed in 1.5% (16/1103) of younger symptomatic patients. The sensitivity of FIT for younger patients aged <50 was 87.5% (95% CI 61.7%-98.4%), 81.3% (54.4%-96.0%) and 68.8% (41.3%-89.0%) at f-Hb cut-offs of 2, 10 and 150 mu g/g, respectively. The positive predictive value for colorectal cancer increased from 4.2% (2.3%-6.9%) to 11.5% (5.9%-19.6%) at cut-offs of 2 and 150 mu g/g, while the positive predictive value for serious bowel disease increased from 31.3% (26.3%-36.5%) to 65.6% (55.2%-75.0%) at the same cut-offs. The negative predictive value of FIT for colorectal cancer remained above 99.5% at all cut-offs. Conclusion Detectable f-Hb on FIT in symptomatic younger patients may indicate referral for investigation of colorectal cancer and serious bowel disease.
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