期刊
BJS OPEN
卷 5, 期 4, 页码 -出版社
OXFORD UNIV PRESS
DOI: 10.1093/bjsopen/zrab056
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类别
资金
- DDI COVID-19 Response & Recovery Small Grant Funding
- Scottish Government
- Chief Scientist Office
- Cancer Research UK
The COVID-19 pandemic has presented unprecedented challenges to healthcare services. This study suggests that using a single qFIT as a triage test for suspected bowel cancer may lead to a high rate of missed cancers, while adding a second qFIT and CT mini-prep can reduce this risk. However, this approach also increases the rate of colonoscopy or CTVC procedures for patients.
Background: COVID-19 has brought an unprecedented challenge to healthcare services. The authors' COVID-adapted pathway for suspected bowel cancer combines two quantitative faecal immunochemical tests (qFITs) with a standard CT scan with oral preparation (CTmini-prep). The aimof this study was to estimate the degree of risk mitigation and residual risk of undiagnosed colorectal cancer. Method: Decision-tree models were developed using a combination of data from the COVID-adapted pathway (April-May 2020), a local audit of qFIT for symptomatic patients performed since 2018, relevant data (prevalence of colorectal cancer and sensitivity and specificity of diagnostic tools) obtained from literature and a local cancer data set, and expert opinion for any missing data. The considered diagnostic scenarios included: single qFIT; two qFITs; single qFIT and CT mini-prep; two qFITs and CT mini-prep (enriched pathway). These were compared to the standard diagnostic pathway (colonoscopy or CT virtual colonoscopy (CTVC)). Results: The COVID-adapted pathway included 422 patients, whereas the audit of qFIT included more than 5000 patients. The risk of missing a colorectal cancer, if present, was estimated as high as 20.2 per cent with use of a single qFIT as a triage test. Using both a second qFIT and a CT mini-prep as add-on tests reduced the risk of missed cancer to 6.49 per cent. The trade-off was an increased rate of colonoscopy or CTVC, from 287 for a single qFIT to 418 for the double qFIT and CT mini-prep combination, per 1000 patients. Conclusion: Triage using qFIT alone could lead to a high rate of missed cancers. This may be reduced using CT mini-prep as an add-on test for triage to colonoscopy or CTVC.
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