Find out more at www.faecal-immunochemical-test.co.uk 7 FIT for Practice? Professor Ramesh Arasaradnam, Consultant Gastroenterologist, University Hospital Coventry & Warwickshire With FIT testing being introduced into primary care, there are many questions to be discussed before widespread implementation. Professor Ramesh Arasaradnam, consultant gastroenterologist at University Hospitals at Coventry and Warwickshire, presents his data on how FIT will fit into primary care, and the advantages it could bring. The data presented was provided by the study conducted at Warwick University Hospital. This included symptomatic patients presenting in primary care, that were suspected of having cancer, and assigned to the two-week-wait (2WW) pathway. The value of the 2WW is discussed in the presentation and importantly notes that only around 7% of cancers are detected in this pathway. The 2WW pathway itself causes a significant strain on endoscopy resource. This study also compares the use of a faecal calprotectin test alongside FIT. In addition it looks at the patient response rate; by including a novel sample collection device (Fe-Col), the pre-analytical variability can be reduced, and the return rate was around 67%, which is higher than in other similar studies. The diagnostic utility of the FIT in this study provides a sensitivity value of 84%, negative predictive value of 99%, and specificity of 82%. The negative predictive value of FIT is the argument used when deciding whether FIT should be a rule-in or –out test. In conjunction with this, it was determined that adding a faecal calprotectin test, the NPV does not change, and the expense of the additional biomarker test, makes the pathway significantly less attractive to funding bodies. The study uses a cut off value of 7 µg of Hb per g of faeces. Using this level, FIT was found to miss fewer cancers than the NG12 pathway. Of the four cancers missed in this FIT study, two of the patients presented with weight loss, and had a palpable abdominal mass. Based on this clinical suspicion, the patients would have been triaged immediately to the 2WW, and are unlikely to have conducted a FIT. Of the four missed cancers, none of them received curative therapy. The cancers were all very advanced, and as a result, these specific cancers, at the very late stage, do not often bleed. Dr Arasaradnam then discusses his views on the NG12 guidance, and references a paper, produced by Quyn et al.1 regarding their research on NICE NG12 and the comparison with FIT. Lastly, the talk concludes with a preview of the recommended colorectal FIT pathway – covering both primary and secondary care. This incorporates the 2WW and the possible application of FIT in the pathway – at the transition stage between primary and secondary care. Reference 1. Quyn AJ, et al. (2018) Application of NICE guideline NG12 to the initial assessment of patients with lower gastrointestinal symptoms: not FIT for purpose? Annals of Clinical Biochemistry. Vol 55, no. 1, pp 69-76. [Online] Available at: https://www.ncbi. nlm.nih.gov/pubmed/28661203 continued....
RkJQdWJsaXNoZXIy MTUyODc1Mw==