2023-05-17 エディンバラ大学
◆この2回の検査は、大腸がんの見逃し診断のリスクを減らすだけでなく、医療システムの負荷を軽減する可能性もあります。大腸がんは英国で4番目に一般的ながんであり、早期発見が重要です。
◆この研究は、大腸がんの早期発見に向けた努力に役立つ結果であり、FIT検査の適切な使用方法を明確化する上でも重要な情報です。
<関連情報>
- https://www.ed.ac.uk/news/2023/double-testing-better-at-identifying-bowel-cancer
- https://academic.oup.com/bjs/article/110/4/471/7035774?login=false
大腸がんが疑われる症状のある患者には、糞便免疫化学検査を2回実施する Double faecal immunochemical testing in patients with symptoms suspicious of colorectal cancer
A D Gerrard, Y Maeda, J Miller, F Gunn, E Theodoratou, C Noble, L Porteous, S Glancy, P MacLean, R Pattenden,M G Dunlop, F V N Din, Edinburgh Colorectal Group
British Journal of Surgery Published:14 February 2023
DOI:https://doi.org/10.1093/bjs/znad016
Abstract
Background
Faecal immunochemical test (FIT)-directed pathways based on a single test have been implemented for symptomatic patients. However, with a single test, the sensitivity is 87 per cent at 10 µg haemoglobin (Hb) per g faeces. This aims of this study were to define the diagnostic performance of a single FIT, compared with double FIT in symptomatic populations.
Methods
Two sequential prospective patient cohorts referred with symptoms from primary care were studied. Patients in cohort 1 were sent a single FIT, and those in cohort 2 received two tests in succession before investigation. All patients were investigated, regardless of having a positive or negative test (threshold 10 µg Hb per g).
Results
In cohort 1, 2260 patients completed one FIT and investigation. The sensitivity of single FIT was 84.1 (95 per cent c.i. 73.3 to 91.8) per cent for colorectal cancer and 67.4 (61.0 to 73.4) per cent for significant bowel pathology. In cohort 2, 3426 patients completed at least one FIT, and 2637 completed both FITs and investigation. The sensitivity of double FIT was 96.6 (90.4 to 99.3) per cent for colorectal cancer and 83.0 (77.4 to 87.8) per cent for significant bowel pathology. The second FIT resulted in a 50.0 per cent reduction in cancers missed by the first FIT, and 30.0 per cent for significant bowel pathology. Correlation between faecal Hb level was only modest (rS = 0.58), and 16.8 per cent of double tests were discordant, 11.4 per cent in patients with colorectal cancer and 18.3 per cent in those with significant bowel pathology.
Conclusion
FIT in patients with high-risk symptoms twice in succession reduces missed significant colorectal pathology and has an acceptable workload impact.
