一项前瞻性单中心研究:粪便免疫化学试验在转介结肠镜检查的有症状患者分诊中的诊断准确性

IF 2.3 4区 医学 Q2 Medicine
Canadian Journal of Gastroenterology and Hepatology Pub Date : 2025-08-22 eCollection Date: 2025-01-01 DOI:10.1155/cjgh/2883395
T Matthews, M O'Sullivan, A Billur, F Janjua, A Aftab, F Zeb, G Courtney
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引用次数: 0

摘要

目的:粪便免疫化学试验(FIT)被NICE认可用于从初级保健转介的症状患者的分类。这项前瞻性诊断准确性研究评估了FIT在二级保健中转诊进行结肠镜检查的有症状患者中检测显著结直肠病理的表现。方法:在2023年5月至2024年5月期间,对1296例转诊的下胃肠内镜(GI)成年患者发放FIT试剂盒。FIT阈值≥50 ng/mL提示紧急结肠镜检查;结果:1113例患者(86%)返回有效FIT结果;215例(19%)FIT阳性。fit阳性患者年龄明显大于fit阴性患者(58岁vs. 54岁,p < 0.01)。在fit阳性患者中,177人(82%)接受了结肠镜检查,而fit阴性患者中有139人(15%)接受了结肠镜检查。在20例fit阳性患者中检测到结直肠癌,而在fit阴性组中未检测到结直肠癌,其敏感性和阴性预测值(NPV)为100%(敏感性95% CI: 83-100, NPV: 97-100)。受试者工作特征(ROC)曲线下面积为0.868 (95% CI: 0.82 ~ 0.91)。对于晚期息肉和炎症病理,敏感性分别为77%和89%,两者的npv均为98%。fit阳性患者平均内镜检查时间较短(7周对21周,p < 0.01)。结论:FIT对结直肠癌具有良好的敏感性,可作为有症状患者安全有效的分诊工具,有助于在资源有限的情况下优化内窥镜服务。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Diagnostic Accuracy of the Faecal Immunochemical Test in Triage of Symptomatic Patients Referred for Colonoscopy: A Prospective Single-Centre Study.

Diagnostic Accuracy of the Faecal Immunochemical Test in Triage of Symptomatic Patients Referred for Colonoscopy: A Prospective Single-Centre Study.

Diagnostic Accuracy of the Faecal Immunochemical Test in Triage of Symptomatic Patients Referred for Colonoscopy: A Prospective Single-Centre Study.

Diagnostic Accuracy of the Faecal Immunochemical Test in Triage of Symptomatic Patients Referred for Colonoscopy: A Prospective Single-Centre Study.

Aim: The faecal immunochemical test (FIT) is endorsed by NICE for triaging symptomatic patients referred from primary care. This prospective diagnostic accuracy study assessed the performance of FIT in detecting significant colorectal pathology among symptomatic patients referred for colonoscopy in secondary care. Method: Between May 2023 and May 2024, FIT kits were distributed to 1296 adult patients referred for lower gastrointestinal (GI) endoscopy. A FIT threshold of ≥ 50 ng/mL prompted urgent colonoscopy; values < 50 ng/mL led to outpatient assessment unless Health Service Executive Priority 1 criteria were met. A complete colonoscopy served as the reference standard. Results: A total of 1113 patients (86%) returned valid FIT results; 215 (19%) were FIT positive. FIT-positive patients were significantly older than FIT-negative patients (58 vs. 54 years, p < 0.01). Among FIT-positive patients, 177 (82%) underwent colonoscopy, compared with 139 (15%) of FIT-negative patients. Colorectal cancer was detected in 20 FIT-positive patients and in none of the FIT-negative group, yielding a sensitivity and negative predictive value (NPV) of 100% (95% CI for sensitivity: 83-100 and NPV: 97-100). The area under the receiver operating characteristic (ROC) curve was 0.868 (95% CI: 0.82-0.91). For advanced polyps and inflammatory pathology, sensitivities were 77% and 89%, with NPVs of 98% for both. The mean time to endoscopy was shorter in FIT-positive patients (7 vs. 21 weeks, p < 0.01). Conclusion: FIT demonstrates excellent sensitivity for colorectal cancer and may serve as a safe, effective triage tool in symptomatic patients, helping optimise endoscopy services in resource-limited settings.

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来源期刊
CiteScore
4.80
自引率
0.00%
发文量
0
审稿时长
37 weeks
期刊介绍: Canadian Journal of Gastroenterology and Hepatology is a peer-reviewed, open access journal that publishes original research articles, review articles, and clinical studies in all areas of gastroenterology and liver disease - medicine and surgery. The Canadian Journal of Gastroenterology and Hepatology is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
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