Imperial College London
Paul Ziprin

Paul Ziprin

Faculty of Medicine, Department of Surgery & Cancer

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

+44 (0)20 3312 7635p.ziprin

 
 
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Assistant

 

Ms Caroline Hurley +44 (0)20 3312 2124

 
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Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{D'Souza:2020:10.1136/gutjnl-2020-321956,
author = {D'Souza, N and Georgiou-Delisle, T and Chen, M and Benton, S and Abulafi, M and The, NICE FIT Steering Group},
doi = {10.1136/gutjnl-2020-321956},
journal = {Gut},
pages = {1130--1138},
title = {Faecal immunochemical test is superior to symptoms in predicting pathology in patients with suspected colorectal cancer symptoms referred on a 2WW pathway; a diagnostic accuracy study},
url = {http://dx.doi.org/10.1136/gutjnl-2020-321956},
volume = {70},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Objective To assess whether a faecal immunochemical test (FIT) could be used to select patients with suspected colorectal cancer (CRC) symptoms for urgent investigation.Design Multicentre, double-blinded diagnostic accuracy study in 50 National Health Service (NHS) hospitals across England between October 2017 and December 2019. Patients referred to secondary care with suspected CRC symptoms meeting NHS England criteria for urgent 2 weeks wait referral and triaged to investigation with colonoscopy were invited to perform a quantitative FIT. The sensitivity of FIT for CRC, and effect of relevant variables on its diagnostic accuracy was assessed.Results 9822 patients were included in the final analysis. The prevalence of CRC at colonoscopy was 3.3%. The FIT positivity decreased from 37.2% to 19.0% and 7.6%, respectively, at cut-offs of 2, 10 and 150 µg haemoglobin/g faeces (µg/g). The positive predictive values of FIT for CRC at these cut-offs were 8.7% (95% CI, 7.8% to 9.7%), 16.1% (95% CI 14.4% to 17.8%) and 31.1% (95% CI 27.8% to 34.6%), respectively, and the negative predictive values were 99.8% (95% CI 99.7% to 99.9%), 99.6% (95% CI 99.5% to 99.7%) and 98.9% (95% CI 98.7% to 99.1%), respectively. The sensitivity of FIT for CRC decreased at the same cut-offs from 97.0% (95% CI 94.5% to 98.5%) to 90.9% (95% CI 87.2% to 93.8%) and 70.8% (95% CI 65.6% to 75.7%), respectively, while the specificity increased from 64.9% (95% CI 63.9% to 65.8%) to 83.5% (95% CI 82.8% to 84.3%) and 94.6% (95% CI 94.1% to 95.0%), respectively. The area under the receiver operating characteristic curve was 0.93 (95% CI 0.92 to 0.95).Conclusion FIT sensitivity is maximised to 97.0% at the lowest cut-off (2 µg/g); a negative FIT result at this cut-off can effectively rule out CRC and a positive FIT result is better than symptoms to select patients for urgent investigations.Trial registration number ISRCTN49676259.
AU  - D'Souza,N
AU  - Georgiou-Delisle,T
AU  - Chen,M
AU  - Benton,S
AU  - Abulafi,M
AU  - The,NICE FIT Steering Group
DO  - 10.1136/gutjnl-2020-321956
EP  - 1138
PY  - 2020///
SN  - 0017-5749
SP  - 1130
TI  - Faecal immunochemical test is superior to symptoms in predicting pathology in patients with suspected colorectal cancer symptoms referred on a 2WW pathway; a diagnostic accuracy study
T2  - Gut
UR  - http://dx.doi.org/10.1136/gutjnl-2020-321956
UR  - https://gut.bmj.com/content/70/6/1130
UR  - http://hdl.handle.net/10044/1/83457
VL  - 70
ER  -
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