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I read with interest the article Five things to know about the appropriate use of fecal immunochemical testing.(1)
I agree with most of the points made and firmly support the view that there is no evidence that fecal occult blood testing (FOBT) and fecal immunochemical testing (FIT) are of any value in assessment of inpatients in secondary care,(2,3) particularly in acute admissions.(4)
However, I would argue strongly that the newer FIT (but not the traditional FOBT) are very useful in the assessment of the many patients presenting in primary care with lower gastrointestinal symptoms.
Significant evidence has accumulated over the last decade that a low fecal hemoglobin concentration is very reassuring in symptomatic patients, since many studies show a very high negative predictive value for significant bowel disease (colorectal cancer, advanced adenoma, and inflammatory bowel disease).(5,6) Moreover, a very high fecal hemoglobin concentration should lead to urgent referral. In Scotland, quantitative FIT are used, and results reported as “not detected” if <10 µg Hb/g feces, numerically if between 10 and 400 µg Hb/g feces and > 400 µg Hb/g feces if above the upper measurement limit of the FIT system used.(7) FIT have been widely introduced as a routine investigation available to general practitioners throughout the UK and are facilitating the referral for colonoscopy for those patients who would most benefit.
No diagnostic test is perfect,...
Show MoreCompeting Interests: CGF acts as a paid consultant to Hitachi Diagnostic Chemical Systems Co., Ltd, Tokyo, Japan, and has accepted support to attend relevant conferences from Alpha Labs Ltd, Eastleigh, Hants, UK.