Annals of Clinical Biochemistry: International Journal of Laboratory Medicine ( IF 2.2 ) Pub Date : 2020-12-17 , DOI: 10.1177/0004563220985547 Craig Mowat 1 , Jayne Digby 2 , Judith A Strachan 3 , Rebecca K McCann 3 , Francis A Carey 4 , Callum G Fraser 2 , Robert Jc Steele 2
Background
Faecal haemoglobin concentration (f-Hb), estimated using a faecal immunochemical test (FIT), can be safely implemented in primary care to assess risk of colorectal cancer (CRC). Clinical outcomes of patients presenting with symptoms of lower gastrointestinal disease were examined using an extensive range of f-Hb thresholds to decide on reassurance or referral for further investigation.
Methods
All patients who attended primary care and submitted a single faecal specimen FIT in the first year of the routine service had f-Hb estimated using HM-JACKarc: f-Hb thresholds from <2 to > 400 µg Hb/g faeces (µg/g) were examined.
Results
Low f-Hb thresholds of <2, <7, <10 and <20 µg/g gave respective CRC risks of 0.1, 0.3, 0.3 and 0.4%, numbers needed to scope (NNS) for one CRC of 871, 335, 300 and 249, and âfalse negativeâ rates of 2.9, 11.4, 13.3 and 17.1%. With thresholds of <2, <7, <10, and <20 µg/g, 48.6, 74.6, 78.1 and 83.2% respectively of symptomatic patients could be managed without further investigation. With reassurance thresholds of <2 µg/g, <7 µg/g and <10 µg/g, the thresholds for referral for urgent investigation would be >400 µg/g, >200 µg/g and >100 µg/g. However, patients with a f-Hb concentration of <10 or <20 µg/g with iron deficiency anaemia, or with severe or persistent symptoms, should not be denied further investigation.
Conclusions
In primary care, f-Hb, in conjunction with clinical assessment, can safely and objectively determine individual risk of CRC and decide on simple reassurance or urgent, or routine referral.
中文翻译：
表达：基于粪便免疫化学测试（FIT）的初级保健患者，粪便血红蛋白浓度阈值可确保大肠癌的放心和急诊。
背景
使用粪便免疫化学测试（FIT）估算的粪便血红蛋白浓度（f-Hb）可在初级保健中安全实施，以评估结直肠癌（CRC）的风险。使用广泛的f-Hb阈值检查出现下消化道疾病症状的患者的临床结局，以决定放心或转诊进一步研究。
方法
所有参加初级保健并在常规服务的第一年提交粪便样本FIT的患者均使用HM-JACKarc估算了f-Hb：f-Hb阈值从<2到> 400 µg Hb / g粪便（µg / g ）进行了检查。
结果
低f-Hb阈值<2，<7，<10和<20 µg / g，分别带来0.1、0.3、0.3和0.4％的CRC风险，一个CRC，871、335、300的范围（NNS）所需的数字和249，以及“假否定” ？??? 率为2.9、11.4、13.3和17.1％。与<2，<7，<10和<20 µg / g的阈值，分别有症状患者的48.6，74.6，78.1和83.2％可以得到管理，而无需进一步调查。使用<2 µg / g，<7 µg / g和<10 µg / g的保证阈值，为紧急调查推荐的阈值将为> 400 µg / g，> 200 µg / g和> 100 µg / g。但是，f-Hb浓度<10或<20 µg / g的患者，缺铁性贫血，或伴有严重或持续的症状，不应拒绝进一步调查。
结论
在初级保健中，f-Hb与临床评估相结合，可以安全，客观地确定个体患CRC的风险，并可以决定是否需要简单的放心或紧急或常规转诊。
京公网安备 11010802027423号