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Setting up a service for a faecal immunochemical test for haemoglobin (FIT): a review of considerations, challenges and constraints
  1. Ian M Godber1,
  2. Sally C Benton2,3,
  3. Callum G Fraser4
  1. 1 Department of Clinical Biochemistry, NHS Lanarkshire, Monklands Hospital, Airdrie, Lanarkshire, UK
  2. 2 Berkshire and Surrey Pathology Services, Royal Surrey County Hospital, Guildford, UK
  3. 3 Bowel Cancer Screening Hub, Guildford, UK
  4. 4 Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
  1. Correspondence to Dr Ian M Godber, Department of Clinical Biochemistry, Monklands Hospital, Airdrie ML60JS, UK; Ian.Godber{at}lanarkshire.scot.nhs.uk

Abstract

Quantitative faecal immunochemical tests for haemoglobin (FIT) have now been advocated by the National Institute for Care and Health Excellence (NICE: DG30) to assist in the triage of patients presenting with symptoms that suggest a low risk of colorectal (bowel) cancer. The evidence is that FIT provides a good rule out test for significant bowel disease. However, a small number of cases will be missed, and robust safety-netting procedures are required to follow up some FIT-negative patients. A range of diagnostic pathways are possible, and there is no best approach at present. Introduction of FIT requires careful consideration of the logistics of supply of devices and information to requesting sites and of transport to the laboratory. A number of FIT analytical systems are available. Three are documented as appropriate for use in assessment of patients with symptoms. However, preanalytical, analytical and postanalytical challenges remain. The methods have different specimen collection devices. The methods use polyclonal antibodies and there is no primary reference material or method to which FIT methods are standardised. Third-party internal quality control is lacking, and external quality assessment schemes have many difficulties in providing appropriate materials. Reporting of results should be done using µg Hb/g faeces units and with knowledge of the limit of detection and limit of quantitation of the analytical system used. FIT can be used successfully in an agreed diagnostic pathway, along with other clinical and laboratory information: this requires a multidisciplinary approach, providing opportunities for professionals in laboratory medicine involvement.

  • colorectal cancer
  • faecal haemoglobin
  • faecal immunochemical test
  • faecal occult blood test
  • lower bowel symptoms
  • significant bowel disease

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Footnotes

  • Handling editor Tahir S Pillay.

  • Contributors All authors contributed equally for the production of this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CGF undertakes consultancy with Kyowa Medex Co, Ltd, Tokyo, Japan, and has received support to attend conferences from Alpha labs Ltd, Eastleigh, Hants, UK.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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