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Review
. 2024 Sep 19;16(18):3199.
doi: 10.3390/cancers16183199.

Repeat Faecal Immunochemical Testing for Colorectal Cancer Detection in Symptomatic and Screening Patients: A Systematic Review and Meta-Analysis

Adam D Gerrard  1   2 , Roberta Garau  1   2 , Wei Xu  1   3 , Yasuko Maeda  4   5 , Malcolm G Dunlop  1   6 , Evropi Theodoratou  1   3 , Farhat V N Din  1   2
Affiliations
Review

Repeat Faecal Immunochemical Testing for Colorectal Cancer Detection in Symptomatic and Screening Patients: A Systematic Review and Meta-Analysis

Adam D Gerrard et al. Cancers (Basel). .

Abstract

Background: Faecal immunochemical testing (FIT) is widely used in bowel screening programmes and assessing symptomatic patients for suspected colorectal cancer (CRC). The evidence for single test performance of FIT in both settings is considerable; however, the use of a repeat test to increase sensitivity remains uncertain. We aimed to review what increase in test positivity would be generated by additional FITs, whether a repeated FIT detects previously missed CRC and advanced colorectal neoplasia (ACRN), and to estimate the sensitivity of double-FIT strategies to diagnose CRC and ACRN.

Methods: A systematic search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) was performed using key search terms. Studies reporting the use of more than one FIT in the same screening round or planned assessment of a single symptomatic patient episode were included. Studies were categorised by the reported study population into asymptomatic, mixed (cohorts of combined asymptomatic, symptomatic, or high-risk surveillance), or symptomatic cohorts.

Results: A total of 68 studies were included for analysis (39 asymptomatic, 21 mixed, 7 symptomatic, and 1 study with discrete asymptomatic and symptomatic data). At a threshold of 10 µg Hb/g, the two-test positivity ranged between 8.1 and 34.5%, with an increase from the second test of 3-9.2 percentage points. Four out of five studies comparing one versus two tests for diagnosing CRC at 10 µg Hb/g identified additional cases with the second test, with a minimum of 50% reduction in missed CRC. At a threshold of 20 µg Hb/g, the second test increased the positivity by 1.3-6.7 percentage points, with a two-test positivity of between 5.1 and 25.0%. Using a threshold of 20 µg Hb/g, five out of seven studies had a 25% reduction in missed CRC. A meta-analysis estimated the double-FIT sensitivity at 10 µg Hb/g for CRC in mixed-risk and symptomatic cohorts to be 94% and 98%, respectively.

Conclusions: Repeated use of FIT helps to diagnose more cases of CRC with a moderate increase in positivity. A double-FIT strategy at 10 µg Hb/g in mixed and symptomatic cohorts has a very high sensitivity for CRC.

Keywords: CRC; FIT; bowel screening; colorectal cancer; colorectal diagnosis; faecal immunochemical testing.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA study flow diagram.
Figure 2
Figure 2
Positivity rates at (A) 10 µg Hb/g and (B) 20 µg Hb/g of the included studies. Positivity rates at a given threshold of one FIT, two FITs, and three FITs. Test was considered positive if any FIT was at or above the given threshold. Quantitative or qualitative FIT type is also shown [7,8,17,23,24,26,27,28,31,32,33,38,40,41,42,43,44,46,47,48,51,54,57,58,59,60,63,64,66,67,69,70,71,76,79,81].
Figure 3
Figure 3
Meta-analysis for sensitivity of detecting CRC and ACRN at 10 µg Hb/g and 20 µg Hb/g for different study populations. [7,8,26,31,38,40,44,57,58,59,63,64,66,67,69,70,71,76,79,81].
Figure 3
Figure 3
Meta-analysis for sensitivity of detecting CRC and ACRN at 10 µg Hb/g and 20 µg Hb/g for different study populations. [7,8,26,31,38,40,44,57,58,59,63,64,66,67,69,70,71,76,79,81].
See this image and copyright information in PMC

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