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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter / Tate, Jillian R.

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IMPACT FACTOR 2017: 3.556

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1437-4331
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Volume 54, Issue 4

Issues

Use of a faecal immunochemical test for haemoglobin can aid in the investigation of patients with lower abdominal symptoms

Ian M. Godber / Louise M. Todd / Callum G. Fraser
  • Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, Dundee, Scotland, UK
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Linda R. MacDonald / Hakim Ben Younes
Published Online: 2015-10-10 | DOI: https://doi.org/10.1515/cclm-2015-0617

Abstract

Background: This study aimed to determine whether patients with lower abdominal symptoms can be investigated quickly using results of faecal haemoglobin concentration (f-Hb) measurements, and whether this test could form part of a diagnostic pathway for significant colorectal disease.

Methods: Nine hundred and nine consecutive patients referred from primary care for colonoscopy were invited: 507 submitted samples for f-Hb measurement with a quantitative faecal immunochemical test for haemoglobin (FIT) (HM-JACKarc, Kyowa-Medex, Japan) and a diagnostic colonoscopy was completed in 484 patients.

Results: Colorectal cancer (CRC), higher risk adenoma (HRA), inflammatory bowel disease (IBD) and/or colitis was found in 45 patients (9.3%); these had significantly higher (p<0.0001) f-Hb than the group of 243 with normal colonoscopy plus the 196 patients with less significant clinical findings. The 11 (2.2%) patients with CRC all had f-Hb >190 μg Hb/g faeces. Using a f-Hb cut-off of 10 μg Hb/g faeces, for the group with CRC or HRA or IBD or colitis, sensitivity was 68.9%, specificity 80.2%, positive predictive value (PPV) 26.3% and negative predictive value (NPV) 96.2%. Sensitivity and NPV were 100% for CRC suggesting f-Hb is a good rule-in test for CRC. Of the 243 patients with normal colonoscopy, 81.2% had f-Hb<10 μg Hb/g faeces.

Conclusions: The high NPV for significant colorectal diseases suggests that f-Hb could be used as a rule-out test in this context. Potential exists for using f-Hb measurements to investigate symptomatic patients and guide the use of colonoscopy resources: detailed algorithms for the introduction of f-Hb measurements requires further exploration.

Keywords: colorectal cancer; colorectal disease; diagnostic accuracy; faecal haemoglobin; faecal immunochemical test; negative predictive value; positive predictive value; sensitivity; specificity

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About the article

Corresponding author: Dr. Ian M. Godber, Consultant Clinical Scientist, NHS Lanarkshire, Department of Biochemistry, Monklands Hospital, Airdrie, Lanarkshire, ML6 0JS, Scotland, UK, E-mail:


Received: 2015-06-30

Accepted: 2015-09-10

Published Online: 2015-10-10

Published in Print: 2016-04-01


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 54, Issue 4, Pages 595–602, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2015-0617.

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