title: An urgent referral strategy for symptomatic patients with suspected colorectal cancer based on a quantitative immunochemical faecal occult blood test.
abstract: BACKGROUND
  European health systems have developed referral guidelines for the selection of patients for the urgent investigation of suspected colorectal cancer.
  
  
  OBJECTIVE
  To evaluate whether quantitative faecal immunochemical testing performs better than commonly used high-risk symptoms based strategies for fast-tracking cancer referrals.
  
  
  METHODS
  We prospectively studied 1054 symptomatic patients referred for a colonoscopy who provided a sample for faecal immunochemical testing. The usefulness of faecal immunochemical testing and two current guidelines for urgent referral were compared for their efficacy in the detection of colorectal cancer and advanced neoplasia.
  
  
  RESULTS
  The guidelines detected 46.7% and 43.3% of cases of colorectal cancer while faecal haemoglobin concentration ≥15μg Hb/g detected 96.7% of cases. The diagnostic accuracy of both the guidelines and faecal haemoglobin concentration ≥15μg Hb/g for the detection of advanced neoplasia was: sensitivity 38.3%, 36.1%, 57.1% and specificity 71.8%, 69.5%, 86.6%, respectively. Male gender (OR 2.35; p<0.001), age (1.34; p=0.002), and faecal haemoglobin concentration ≥10μg Hb/g (7.81; p<0.001) were independent predictive factors of advanced neoplasia.
  
  
  CONCLUSIONS
  A faecal immunochemical test based-strategy performs better than current high-risk symptoms based strategies for fast-tracking cancer referrals. A score that combines gender, age and a faecal immunochemical test could accurately estimate the risk of advanced neoplasia.
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: Rodríguez-Alonso
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Ciber de Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Rodríguez-Moranta
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ruiz-Cerulla
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Triana
authors.initials: T
authors.lastname: Lobatón
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Clàudia
authors.initials: C
authors.lastname: Arajol
authors.affiliation: Catalan Institute of Oncology, Cancer Prevention and Control Programme, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Ciber de Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Binefa
authors.affiliation: Catalan Institute of Oncology, Cancer Prevention and Control Programme, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Ciber de Epidemiología y Salud Pública (CIBERESP), Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Moreno
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: jguardiola@bellvitgehospital.cat.
authors.forename: Jordi
authors.initials: J
authors.lastname: Guardiola
mesh_terms: D000328:Adult; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D009780:Occult Blood; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D012372:ROC Curve; D012017:Referral and Consultation / Q000592:standards*; D012680:Sensitivity and Specificity
keywords: Colorectal cancer; Diagnostic accuracy study; Faecal immunochemical test; Fast-track referral