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Original research
Faecal immunochemical tests safely enhance rational use of resources during the assessment of suspected symptomatic colorectal cancer in primary care: systematic review and meta-analysis
  1. Noel Pin-Vieito1,2,3,4,
  2. Coral Tejido-Sandoval1,
  3. Natalia de Vicente-Bielza1,
  4. Cristina Sánchez-Gómez1,
  5. Joaquín Cubiella1,2,3
  1. 1Gastroenterology, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
  2. 2Instituto de Investigacíon Sanitaria Galicia Sur, Ourense, Spain
  3. 3Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Ourense, Spain
  4. 4Biochemistry, Genetics and Immunology, Faculty of Biology, University of Vigo, Vigo, Spain
  1. Correspondence to Dr Joaquín Cubiella, Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Ourense, Spain; Joaquin.Cubiella.Fernandez{at}sergas.es

Abstract

Objective Implementation of faecal immunochemical tests (FIT) as a triage test in primary healthcare may improve the efficiency of referrals without missing cases of colorectal cancer (CRC). We aim to summarise the performance characteristics of FITs for CRC in symptomatic patients presenting to primary healthcare.

Design We performed a systematic literature review of Medline and EMBASE databases from May 2018 to November 2020. Previous related systematic searches were also adapted to this aim and completed with reference screening. We identified studies performed on adult patients consulting for abdominal symptoms in primary care which reported data such that the FIT diagnostic performance parameters for CRC could be obtained. Bivariate models were used to synthesise available evidence. Meta-regression analysis was performed to evaluate the causes of heterogeneity.

Results Twenty-three studies (69 536 participants) were included (CRC prevalence 0.3%–6.2%). Six studies (n=34 691) assessed FIT as rule in test (threshold of ≥150 µg Hb/g faeces) showing a sensitivity of 64.1% (95% CI 57.8% to 69.9%) and a specificity of 95.0% (95% CI 91.2% to 97.2%). A threshold of 10 µg/g (15 studies; n=48 872) resulted in a sensitivity of 87.2% (95% CI 81.0% to 91.6%) and a specificity of 84.4% (95% CI 79.4% to 88.3%) for CRC. At a 20 µg Hb/g faeces threshold (five studies; n=24 187) less than one additional CRC would be missed per 1000 patients investigated compared with 10 µg Hb/g faeces threshold (CRC prevalence 2%).

Conclusion FIT is the test of choice to evaluate patients with new-onset lower gastrointestinal symptoms in primary healthcare.

  • clinical decision making
  • colonoscopy
  • colorectal cancer
  • endoscopy
  • stool markers

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Data obtained from the systematic review and meta-analysis are included in the article and online supplemental material.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Data obtained from the systematic review and meta-analysis are included in the article and online supplemental material.

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Footnotes

  • Contributors NPV and JC conceived and designed the research. NPV, CT-S, NdV-B and CS-G performed data acquisition. NPV analysed and interpretated data. NPV and JC drafted the article or made critical revisions related to important intellectual content of the manuscript. All the authors gave their final approval of the version of the article to be published.

  • Funding This work was financed by Spain’s Carlos III Health Care Institute by means of project PI17/00837 (Co-funded by European Regional Development Fund/European Social Fund 'A way to make Europe'/'Investing in your future').

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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