Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Mar 28;15(7):2011.
doi: 10.3390/cancers15072011.

Possible Value of Faecal Immunochemical Test (FIT) When Added in Symptomatic Patients Referred for Colonoscopy: A Systematic Review

Henrike Jacoba Brands  1 , Brigit Van Dijk  1 , Richard M Brohet  2 , Henderik L van Westreenen  3 , Jan Willem B de Groot  4 , Leon M G Moons  5 , Wouter H de Vos Tot Nederveen Cappel  1
Affiliations
Review

Possible Value of Faecal Immunochemical Test (FIT) When Added in Symptomatic Patients Referred for Colonoscopy: A Systematic Review

Henrike Jacoba Brands et al. Cancers (Basel). .

Abstract

If Colorectal cancer (CRC) is detected and treated early, the survival rate is high. This is one of the reasons that population-based screening programs for the early detection of CRC using the faecal immunochemical test (FIT) started worldwide. These programs compete with regular colonoscopy programs and increase the waiting time for symptomatic patients. However, the literature has shown that the correlation between intestinal complaints and the gain of colonoscopy is poor. The aim of this study is to assess the diagnostic utility of symptoms for the yield (CRC) of colonoscopy and to compare this with the diagnostic utility of FIT when offered to symptomatic patients.

Methods: We performed a systematic review search for CRC as an outcome of colonoscopy in referred symptomatic patients and separately for CRC as an outcome in symptomatic patients with a positive FIT. We searched systematically for clinical trials or observational studies in databases, followed by hand-searching of reference lists. We used random Meta-Disc to evaluate the diagnostic performance, using the exploration of heterogeneity with a variety of test statistics and by computing the pooled estimates.

Results: We included 35 studies, with almost 5 million symptomatic patients. In addition, we included nine prospective studies with a positive FIT in symptomatic patients, with more than 5000 patients. Significant heterogeneity was found for every symptom and the outcome of colonoscopy in the effect size of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio. In a random effect model, the pooled sensitivity of colonoscopy in symptomatic patients was very low (25%). However, the pooled sensitivity in symptomatic patients with a positive FIT was 83% and the pooled specificity 77%. A total of 75 symptomatic patients (1.4%) had a false-negative FIT.

Conclusion: Adding FIT in symptomatic patients seems useful for predicting CRC as an outcome of colonoscopy. FIT seems a potential tool for an improved triage of colonoscopy in symptomatic patients.

Keywords: colorectal cancer; faecal immunochemical test (FIT); symptoms.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The publication searching procedure.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Ferlay J., Autier P., Boniol M., Heanue M., Colombet M., Boyle P. Estimates of the cancer incidence and mortality in Europe in 2006. Ann. Oncol. 2007;18:581–592. doi: 10.1093/annonc/mdl498. - DOI - PubMed
    1. Knottnerus J.A. Bevolkingsonderzoek naar darmkanker. Bijblijven. 2009;25:34–44.
    1. O’Connell J.B., Maggard M.A., Ko C.Y. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J. Natl. Cancer Inst. 2004;96:1420–1425. doi: 10.1093/jnci/djh275. - DOI - PubMed
    1. Van Veldhuizen-Eshuis H., Carpay M.E.M., van Delden J.A., Grievink L., Hoebee B., Lock A.J.J., Reij R. Uitvoeringstoets Bevolkingsonderzoek Darmkanker: Opsporing van Darmkanker in Praktijk Gebracht. National Institute for Public Health and the Environment; Bilthoven, MA, USA: 2011.
    1. Adelstein B.-A., Macaskill P., Chan S.F., Katelaris P.H., Irwig L. Most bowel cancer symptoms do not indicate colorectal cancer and polyps: A systematic review. BMC Gastroenterol. 2011;11:65. doi: 10.1186/1471-230X-11-65. - DOI - PMC - PubMed

LinkOut - more resources