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Yield of colorectal cancer at colonoscopy according to faecal haemoglobin concentration in symptomatic patients referred from primary care.
McSorley, Stephen T; Digby, Jayne; Clyde, Danielle; Cruickshank, Neil; Burton, Paul; Barker, Louise; Strachan, Judith A; Fraser, Callum G; Smith, Karen; Mowat, Craig; Winter, Jack; Steele, Robert J C.
  • McSorley ST; Academic Unit of Surgery, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
  • Digby J; Centre for Research into Cancer Prevention and Screening, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
  • Clyde D; Department of Surgery, NHS Fife, Victoria Hospital, Kirkcaldy, UK.
  • Cruickshank N; Department of Surgery, NHS Fife, Victoria Hospital, Kirkcaldy, UK.
  • Burton P; eHealth, Corporate Services, Business Intelligence, NHS Greater Glasgow and Clyde, Glasgow, UK.
  • Barker L; Department of Surgery, NHS Fife, Victoria Hospital, Kirkcaldy, UK.
  • Strachan JA; Department of Blood Sciences, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK.
  • Fraser CG; Centre for Research into Cancer Prevention and Screening, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
  • Smith K; Department of Clinical Biochemistry, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, UK.
  • Mowat C; Department of Gastroenterology, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK.
  • Winter J; Department of Gastroenterology, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK.
  • Steele RJC; Centre for Research into Cancer Prevention and Screening, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
Colorectal Dis ; 23(7): 1615-1621, 2021 07.
Article in English | MEDLINE | ID: covidwho-868067
ABSTRACT

AIM:

Lower gastrointestinal (GI) symptoms are poor predictors of colorectal cancer (CRC). The aim of this study was to examine the diagnostic yield of colonoscopy by faecal haemoglobin (f-Hb) concentration in symptomatic patients assessed in primary care by faecal immunochemical testing (FIT).

METHOD:

In three Scottish NHS Boards, FIT kits (HM-JACKarc, Hitachi Chemical Diagnostics Systems Co., Ltd, Tokyo, Japan) were used by general practitioners to guide referrals for patients with lower GI symptoms (laboratory data studied for 12 months from December 2015 onwards in Tayside, 18 months from June 2018 onwards in Fife and 5 months from September 2018 onwards in Greater Glasgow and Clyde). Cases of CRC diagnosed at colonoscopy were ascertained from colonoscopy and pathology records.

RESULTS:

Four thousand eight hundred and forty one symptomatic patients who underwent colonoscopy after FIT submission were included. Of the 2166 patients (44.7%) with f-Hb <10 µg Hb/g faeces (µg/g), 14 (0.6%) were diagnosed with CRC, with a number needed to scope (NNS) of 155. Of the 2675 patients (55.3%) with f-Hb ≥10 µg/g, 252 were diagnosed with CRC (9.4%) with a NNS of 11. Of the 705 patients with f-Hb ≥400 µg/g, 158 (22.4%) were diagnosed with CRC with a NNS of 5. Over half of those diagnosed with CRC with f-Hb <10 µg/g had coexisting anaemia.

CONCLUSION:

Symptomatic patients with f-Hb ≥10 µg/g should undergo further investigation for CRC, while higher f-Hb concentrations could be used to triage for urgency during the COVID-19 recovery phase. Patients with f-Hb <10 µg/g and without anaemia are very unlikely to be diagnosed with CRC and the majority need no further investigation.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Colorectal Neoplasms / COVID-19 Type of study: Diagnostic study / Prognostic study Limits: Humans Language: English Journal: Colorectal Dis Journal subject: Gastroenterology Year: 2021 Document Type: Article Affiliation country: Codi.15405

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Colorectal Neoplasms / COVID-19 Type of study: Diagnostic study / Prognostic study Limits: Humans Language: English Journal: Colorectal Dis Journal subject: Gastroenterology Year: 2021 Document Type: Article Affiliation country: Codi.15405