Service evaluation of faecal immunochemical testing introduced for use in North East London for patients at low risk of colorectal cancer
AimsColorectal cancer (CRC) is the fourth most common cancer in the UK. Following National Institute of Clinical Excellence (NICE) guidance for faecal immunochemical testing (FIT) (DG30), we introduced a service for the measurement of faecal haemoglobin (fHb) in symptomatic patients in line with the...
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| Veröffentlicht in: | Journal of clinical pathology 2021-03, Vol.74 (3), p.163-166 |
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| description | AimsColorectal cancer (CRC) is the fourth most common cancer in the UK. Following National Institute of Clinical Excellence (NICE) guidance for faecal immunochemical testing (FIT) (DG30), we introduced a service for the measurement of faecal haemoglobin (fHb) in symptomatic patients in line with the 2017 update of the NG12 guidance. The purpose of this study was to audit the use of FIT, focussing on the indication for request and referral for diagnostic tests as recommended in NICE guidance.MethodsTesting was rolled out after careful introduction with extensive education led by the local Cancer Alliance and reinforced by the laboratory. After 6 months, the outcomes of all patients tested were reviewed.Results1203 samples were received, of which 894 (74.3%) were suitable for analysis. Of these, 482 (53.9%) actually met the criteria for FIT analysis stipulated in our patient pathway. Eight patients were diagnosed with CRC; fHb was detectable in all and was ≥200 µg/g in seven and |
| doi_str_mv | 10.1136/jclinpath-2020-206632 |
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Following National Institute of Clinical Excellence (NICE) guidance for faecal immunochemical testing (FIT) (DG30), we introduced a service for the measurement of faecal haemoglobin (fHb) in symptomatic patients in line with the 2017 update of the NG12 guidance. The purpose of this study was to audit the use of FIT, focussing on the indication for request and referral for diagnostic tests as recommended in NICE guidance.MethodsTesting was rolled out after careful introduction with extensive education led by the local Cancer Alliance and reinforced by the laboratory. After 6 months, the outcomes of all patients tested were reviewed.Results1203 samples were received, of which 894 (74.3%) were suitable for analysis. Of these, 482 (53.9%) actually met the criteria for FIT analysis stipulated in our patient pathway. Eight patients were diagnosed with CRC; fHb was detectable in all and was ≥200 µg/g in seven and <10 µg/g in one. 217 patients underwent gastrointestinal investigations, and the sensitivity and specificity of FIT for CRC were found to be 87.5% (95% CI 46.6% to 99.7%) and 52.6% (95% CI 45.6% to 59.6%), respectively. Patients with anaemia were more likely to have fHb ≥10 µg/g.ConclusionsThese findings suggest benefits from the introduction of FIT in terms of more efficient use of diagnostic investigations, while revealing initial problems relating to familiarity with a new test. This merits further intervention with education and awareness programmes for Primary Care and further audit.</description><identifier>ISSN: 0021-9746</identifier><identifier>EISSN: 1472-4146</identifier><identifier>DOI: 10.1136/jclinpath-2020-206632</identifier><identifier>PMID: 32646926</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and Association of Clinical Pathologists</publisher><subject>Abdomen ; Adult ; Age ; Aged ; Aged, 80 and over ; Anemia ; Anemia - diagnosis ; Anemia - metabolism ; Biochemistry ; Colorectal cancer ; colorectal neoplasms ; Colorectal Neoplasms - diagnosis ; Colorectal Neoplasms - metabolism ; Demographics ; Demography ; diagnosis ; Diagnostic Tests, Routine ; Feces - chemistry ; Female ; gastroenterology ; gastrointestinal neoplasms ; Gastrointestinal Neoplasms - diagnosis ; Gastrointestinal Neoplasms - metabolism ; Hemoglobin ; Hemoglobins - analysis ; Humans ; Immunochemistry ; Inflammatory bowel disease ; Iron ; Laboratories ; London ; Male ; Medical screening ; Middle Aged ; Original research ; Pain ; Patients ; Primary care ; Primary Health Care ; Quality control ; Referral and Consultation ; Risk ; Sensitivity and Specificity ; Statistical analysis ; Tumors ; Young Adult</subject><ispartof>Journal of clinical pathology, 2021-03, Vol.74 (3), p.163-166</ispartof><rights>Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2021 Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b420t-d82dd91650ca201169fe4ef6bdba18d33418f005b1cc5c077766a77c2cf944c13</citedby><cites>FETCH-LOGICAL-b420t-d82dd91650ca201169fe4ef6bdba18d33418f005b1cc5c077766a77c2cf944c13</cites><orcidid>0000-0003-4662-2502</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32646926$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ayling, Ruth M</creatorcontrib><creatorcontrib>Machesney, Michael</creatorcontrib><title>Service evaluation of faecal immunochemical testing introduced for use in North East London for patients at low risk of colorectal cancer</title><title>Journal of clinical pathology</title><addtitle>J Clin Pathol</addtitle><addtitle>J Clin Pathol</addtitle><description>AimsColorectal cancer (CRC) is the fourth most common cancer in the UK. Following National Institute of Clinical Excellence (NICE) guidance for faecal immunochemical testing (FIT) (DG30), we introduced a service for the measurement of faecal haemoglobin (fHb) in symptomatic patients in line with the 2017 update of the NG12 guidance. The purpose of this study was to audit the use of FIT, focussing on the indication for request and referral for diagnostic tests as recommended in NICE guidance.MethodsTesting was rolled out after careful introduction with extensive education led by the local Cancer Alliance and reinforced by the laboratory. After 6 months, the outcomes of all patients tested were reviewed.Results1203 samples were received, of which 894 (74.3%) were suitable for analysis. Of these, 482 (53.9%) actually met the criteria for FIT analysis stipulated in our patient pathway. Eight patients were diagnosed with CRC; fHb was detectable in all and was ≥200 µg/g in seven and <10 µg/g in one. 217 patients underwent gastrointestinal investigations, and the sensitivity and specificity of FIT for CRC were found to be 87.5% (95% CI 46.6% to 99.7%) and 52.6% (95% CI 45.6% to 59.6%), respectively. Patients with anaemia were more likely to have fHb ≥10 µg/g.ConclusionsThese findings suggest benefits from the introduction of FIT in terms of more efficient use of diagnostic investigations, while revealing initial problems relating to familiarity with a new test. This merits further intervention with education and awareness programmes for Primary Care and further audit.</description><subject>Abdomen</subject><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anemia</subject><subject>Anemia - diagnosis</subject><subject>Anemia - metabolism</subject><subject>Biochemistry</subject><subject>Colorectal cancer</subject><subject>colorectal neoplasms</subject><subject>Colorectal Neoplasms - diagnosis</subject><subject>Colorectal Neoplasms - metabolism</subject><subject>Demographics</subject><subject>Demography</subject><subject>diagnosis</subject><subject>Diagnostic Tests, Routine</subject><subject>Feces - chemistry</subject><subject>Female</subject><subject>gastroenterology</subject><subject>gastrointestinal neoplasms</subject><subject>Gastrointestinal Neoplasms - diagnosis</subject><subject>Gastrointestinal Neoplasms - metabolism</subject><subject>Hemoglobin</subject><subject>Hemoglobins - analysis</subject><subject>Humans</subject><subject>Immunochemistry</subject><subject>Inflammatory bowel disease</subject><subject>Iron</subject><subject>Laboratories</subject><subject>London</subject><subject>Male</subject><subject>Medical screening</subject><subject>Middle Aged</subject><subject>Original research</subject><subject>Pain</subject><subject>Patients</subject><subject>Primary care</subject><subject>Primary Health Care</subject><subject>Quality control</subject><subject>Referral and Consultation</subject><subject>Risk</subject><subject>Sensitivity and Specificity</subject><subject>Statistical analysis</subject><subject>Tumors</subject><subject>Young Adult</subject><issn>0021-9746</issn><issn>1472-4146</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkc-OFCEYxInRuOPqI2hIvHhp5V_DcDSbXTWZ6EE9d2j4cBi7YQR6jY_gW0tn1jHxYLxAgF8VBYXQU0peUsrlq4OdQjyauu8YYaQNUnJ2D22oUKwTVMj7aEMIo51WQl6gR6UcCKFcUf4QXXAmhdRMbtDPj5BvgwUMt2ZaTA0p4uSxN2DNhMM8LzHZPcxhXVYoNcQvOMSak1ssOOxTxkuBtoXfp1z3-NqUincpuma0HraIAWIt2FQ8pe84h_J1vcGmKWWwtdlaEy3kx-iBN1OBJ3fzJfp8c_3p6m23-_Dm3dXrXTcKRmrntsw5TWVPrGGEUqk9CPBydKOhW8e5oFtPSD9Sa3tLlFJSGqUss14LYSm_RC9Ovsecvi3tRcMcioVpMhHSUgYmGG-f2VPe0Od_oYe05NjSNUqTrdZa6Ub1J8rmVEoGPxxzmE3-MVAyrF0N566Gtavh1FXTPbtzX8YZ3Fn1u5wGkBMwzof_9qR_JOew_9b8AoBosyU</recordid><startdate>20210301</startdate><enddate>20210301</enddate><creator>Ayling, Ruth M</creator><creator>Machesney, Michael</creator><general>BMJ Publishing Group Ltd and Association of Clinical Pathologists</general><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4662-2502</orcidid></search><sort><creationdate>20210301</creationdate><title>Service evaluation of faecal immunochemical testing introduced for use in North East London for patients at low risk of colorectal cancer</title><author>Ayling, Ruth M ; Machesney, Michael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b420t-d82dd91650ca201169fe4ef6bdba18d33418f005b1cc5c077766a77c2cf944c13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abdomen</topic><topic>Adult</topic><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anemia</topic><topic>Anemia - diagnosis</topic><topic>Anemia - metabolism</topic><topic>Biochemistry</topic><topic>Colorectal cancer</topic><topic>colorectal neoplasms</topic><topic>Colorectal Neoplasms - diagnosis</topic><topic>Colorectal Neoplasms - metabolism</topic><topic>Demographics</topic><topic>Demography</topic><topic>diagnosis</topic><topic>Diagnostic Tests, Routine</topic><topic>Feces - chemistry</topic><topic>Female</topic><topic>gastroenterology</topic><topic>gastrointestinal neoplasms</topic><topic>Gastrointestinal Neoplasms - diagnosis</topic><topic>Gastrointestinal Neoplasms - metabolism</topic><topic>Hemoglobin</topic><topic>Hemoglobins - analysis</topic><topic>Humans</topic><topic>Immunochemistry</topic><topic>Inflammatory bowel disease</topic><topic>Iron</topic><topic>Laboratories</topic><topic>London</topic><topic>Male</topic><topic>Medical screening</topic><topic>Middle Aged</topic><topic>Original research</topic><topic>Pain</topic><topic>Patients</topic><topic>Primary care</topic><topic>Primary Health Care</topic><topic>Quality control</topic><topic>Referral and Consultation</topic><topic>Risk</topic><topic>Sensitivity and Specificity</topic><topic>Statistical analysis</topic><topic>Tumors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ayling, Ruth M</creatorcontrib><creatorcontrib>Machesney, Michael</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ayling, Ruth M</au><au>Machesney, Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Service evaluation of faecal immunochemical testing introduced for use in North East London for patients at low risk of colorectal cancer</atitle><jtitle>Journal of clinical pathology</jtitle><stitle>J Clin Pathol</stitle><addtitle>J Clin Pathol</addtitle><date>2021-03-01</date><risdate>2021</risdate><volume>74</volume><issue>3</issue><spage>163</spage><epage>166</epage><pages>163-166</pages><issn>0021-9746</issn><eissn>1472-4146</eissn><abstract>AimsColorectal cancer (CRC) is the fourth most common cancer in the UK. Following National Institute of Clinical Excellence (NICE) guidance for faecal immunochemical testing (FIT) (DG30), we introduced a service for the measurement of faecal haemoglobin (fHb) in symptomatic patients in line with the 2017 update of the NG12 guidance. The purpose of this study was to audit the use of FIT, focussing on the indication for request and referral for diagnostic tests as recommended in NICE guidance.MethodsTesting was rolled out after careful introduction with extensive education led by the local Cancer Alliance and reinforced by the laboratory. After 6 months, the outcomes of all patients tested were reviewed.Results1203 samples were received, of which 894 (74.3%) were suitable for analysis. Of these, 482 (53.9%) actually met the criteria for FIT analysis stipulated in our patient pathway. Eight patients were diagnosed with CRC; fHb was detectable in all and was ≥200 µg/g in seven and <10 µg/g in one. 217 patients underwent gastrointestinal investigations, and the sensitivity and specificity of FIT for CRC were found to be 87.5% (95% CI 46.6% to 99.7%) and 52.6% (95% CI 45.6% to 59.6%), respectively. Patients with anaemia were more likely to have fHb ≥10 µg/g.ConclusionsThese findings suggest benefits from the introduction of FIT in terms of more efficient use of diagnostic investigations, while revealing initial problems relating to familiarity with a new test. This merits further intervention with education and awareness programmes for Primary Care and further audit.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and Association of Clinical Pathologists</pub><pmid>32646926</pmid><doi>10.1136/jclinpath-2020-206632</doi><tpages>4</tpages><orcidid>https://orcid.org/0000-0003-4662-2502</orcidid></addata></record> |
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| subjects | Abdomen Adult Age Aged Aged, 80 and over Anemia Anemia - diagnosis Anemia - metabolism Biochemistry Colorectal cancer colorectal neoplasms Colorectal Neoplasms - diagnosis Colorectal Neoplasms - metabolism Demographics Demography diagnosis Diagnostic Tests, Routine Feces - chemistry Female gastroenterology gastrointestinal neoplasms Gastrointestinal Neoplasms - diagnosis Gastrointestinal Neoplasms - metabolism Hemoglobin Hemoglobins - analysis Humans Immunochemistry Inflammatory bowel disease Iron Laboratories London Male Medical screening Middle Aged Original research Pain Patients Primary care Primary Health Care Quality control Referral and Consultation Risk Sensitivity and Specificity Statistical analysis Tumors Young Adult |
| title | Service evaluation of faecal immunochemical testing introduced for use in North East London for patients at low risk of colorectal cancer |
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