Leading Edge 2021 Issue 2

Find out more at: www.alphalabs.co.uk/fpela 9 Further Expansion To further expand the use of FIT, healthcare decision makers are looking beyond the original DG30 and NG12 guidelines and starting to assess the value of FIT in the younger population. With the incidence of CRC on the rise in the under 50s, the test must prove valuable in yet another cohort, and early studies are showing promising results . This is yet further evidence that with well-structured pathways, and appropriate efficacy studies, it is possible for FIT to be of even more value to lower-GI diagnostics. is important to use any diagnostic test with a full understanding of its limitations. Ensuring adequate safety netting is one of the most important aspects to any diagnostic service: and although FIT has a high negative predictive value for CRC (>98%) there is still a risk that cancer (or SBD) is missed. The key to further expanding FIT application is to ensure it is done safely and efficiently: monitoring patient outcomes, and ensuring the capacity challenges are resolved, not just displaced to another service. Overall, the diversification of FIT applications has been accelerated by COVID-19. By remaining cognisant of its limitations, and creating robust safety netting procedures, FIT applications will continue to diversify over the coming months. Applications in primary and secondary care, VSP and RDC, and expanding to the younger cohort, shows the true value of FIT may yet to be fully appreciated, and it is anticipated that the pathway changes will become routine and continue to help improve patient care, and resource management in the NHS for years to come. References / Sources: 1 National Institute for Health and Care Excellence (2017) Quantitative faecal immunochemical tests to guide referral for colorectal cancer in primary care. Diagnostics guidance [DG30]. [online]. Available at https://www.nice.org.uk/guidance/ dg30 (Accessed 15 July 2021) 2 National Institute for Health and Care Excellence (2021) Suspected cancer: recognition and referral NICE guideline [NG12]. [online]. Available at https://www.nice.org.uk/guidance/ng12 (Accessed 15 July 2021) 3 Strachan, J. A. and Mowat, C. (2021) The use of faecal haemoglobin in deciding which patients presenting to primary care require further investigation (and how quickly) – the FIT approach. [Online], The Journal of the International Federation of Clinical Chemistry and Laboratory Medicine (eJIFCC). Vol. 32, No. 1, pp. 52-60. Available at https:// www.faecal-immunochemical-test.co.uk/ wp/wp-content/uploads/2021/03/ejifcc2021-FIT-Strachan-and-Mowat.pdf (Accessed 15 July 2021) 4 D’Souza, N., Monahan, K., Benton, S. C., Wilde, L., Abulafi, M., The NICE FIT Steering Group. (2021). Finding the needle in the haystack; the diagnostic accuracy of the faecal immunochemical test for colorectal cancer in younger symptomatic patients. [Online]. Colorectal Disease. Available at https://onlinelibrary.wiley.com/ doi/10.1111/codi.15786?af=R (Accessed 15 July 2021) However, it Q. A.  Q. A.  Q. A.  Q. A.  Vague Symptoms Pathways (VSP)