Abstract Background This review evaluated the utility of single quantitative faecal immunochemical test (FIT) as a triaging tool for patients with symptoms of possible colorectal cancer, the effect of symptoms on FIT accuracy, and the impact of triaging incorporating FIT on service provision. Methods Five databases were searched. Meta-analyses of the extracted FIT sensitivities and specificities for detection of colorectal cancer at reported f-Hb thresholds were performed. Secondary outcomes included sensitivity and specificity of FIT for advanced colorectal neoplasia and serious bowel disease. Subgroup analysis by FIT brand and symptoms was undertaken. Results Fifteen prospective cohort studies, including 28 832 symptomatic patients were included. At the most commonly reported f-Hb positivity threshold of ≥ 10 µg Hb/g faeces (n=13), the summary sensitivity was 88.7% (95% c.i. 85.2 to 91.4) and the specificity was 80.5% (95% c.i. 75.3 to 84.8) for colorectal cancer. At lower limits of detection of ≥ 2 µg Hb/g faeces, the summary sensitivity was 96.8% (95% c.i. 91.0 to 98.9) and the specificity was 65.6% (95% c.i. 59.0 to 71.6). At the upper f-Hb positivity thresholds of ≥ 100 µg Hb/g faeces and ≥ 150 µg Hb/g faeces, summary sensitivities were 68.1% (95% c.i. 59.2 to 75.9) and 66.3% (95% c.i. 52.2 to 78.0), with specificities of 93.4% (95% c.i. 91.3 to 95.1) and 95.1% (95% c.i. 93.6 to 96.3) respectively. FIT sensitivity was comparable between different assay brands. FIT sensitivity may be higher in patients reporting rectal bleeding. Conclusion Single quantitative FIT at lower f-Hb positivity thresholds can adequately exclude colorectal cancer in symptomatic patients and provides a data-based approach to prioritization of colonoscopy resources.

中文翻译：

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粪便免疫化学检测对可能患有结直肠癌症状的患者进行分类：荟萃分析

摘要 背景本综述评估了单一定量粪便免疫化学检测 (FIT) 作为对可能患有结直肠癌症状的患者进行分类工具的效用、症状对 FIT 准确性的影响，以及纳入 FIT 分类对服务提供的影响。 方法检索了五个数据库。对提取的 FIT 在报告的 f-Hb 阈值下检测结直肠癌的敏感性和特异性进行了荟萃分析。次要结果包括 FIT 对晚期结直肠肿瘤和严重肠道疾病的敏感性和特异性。按 FIT 品牌和症状进行亚组分析。 结果纳入 15 项前瞻性队列研究，包括 28 832 名有症状的患者。在最常报道的 f-Hb 阳性阈值≥ 10 µg Hb/g 粪便 (n=13) 时，总体敏感性为 88.7%（95% CI 85.2 至 91.4），特异性为 80.5%（95% CI 75.3 至 91.4）。 84.8）用于结直肠癌。在检测下限≥ 2 µg Hb/g 粪便时，总体敏感性为 96.8%（95% ci 91.0 至 98.9），特异性为 65.6%（95% ci 59.0 至 71.6）。在 f-Hb 阳性上限≥ 100 µg Hb/g 粪便和 ≥ 150 µg Hb/g 粪便时，总体敏感性分别为 68.1%（95% CI 59.2 至 75.9）和 66.3%（95% CI 52.2 至 78.0），特异性分别为 93.4%（95% CI 91.3 至 95.1）和 95.1%（95% CI 93.6 至 96.3）。不同检测品牌之间的 FIT 灵敏度相当。报告直肠出血的患者的 FIT 敏感性可能更高。 结论较低 f-Hb 阳性阈值的单次定量 FIT 可以充分排除有症状患者的结直肠癌，并提供基于数据的方法来确定结肠镜检查资源的优先级。