HM-JACKarc References

The fully automated fecal occult blood test analyser HM-JACK was shown to yield basically favourable intra- and inter-day precision and accuracy, sufficient measurement range, and stability of HB after stood sampling, among other features. This analyser is fast and easy to use, analysing 180 samples per hour. […] the HM-JACK appears to be useful testing analyser in terms of routine practice.

In conclusion, the EXTEL HEMO-AUTO MC Collection Picker is robustly designed so that excess faecal sample loaded by participants, or material remaining in the dimple(s) does not affect the f-Hb.

Use of correct nomenclature for the lowest f-Hb that can be used in academic and routine practice is urgently needed, as are reporting strategies, with harmonisation across manufacturers, suppliers, researchers, reviewers, journal editors and all users.

The mass of sample loaded onto the probe did not impact the f-Hb significantly using all four tested devices.

Of 20 common Hb variants studied, 17 did not affect detection of Hb by the FIT systems tested. Hb variants leading to a reduction in the presence of a globin chain caused a reduction in Hb detection; in such cases, cancers could be missed.

This study concludes that FIT is suited for use as a rule-out test due to its high NPV. The diagnostic yield of collecting two samples for FIT can be achieved with one sample, but a lower faecal haemoglobin concentration (f-Hb) cut-off is required. The use of the HM-JACKarc in this study emphasises the value of low-end sensitivity, and the reduced cut-off level would be sufficient to reduce the requirement for two patient samples.

Comparing two protocols, one using artificial biological samples, and the other using clinical samples, it was possible to determine the effect of preanalytical and analytical variation. The HM-JACKarc was compared favourably with another analyser and both machines indicate that the sample collection devices were key to reducing preanalytical and analytical errors.

When applied to FIT negative group, urinary VOCs improves CRC detection (sensitivity rises from 0.80 to 0.97)   thus showing promise as a second stage test to complement FIT in CRC detection.

In this low-risk symptomatic patient group, the proportion of samples considered positive by FIT was considerably lower than gFOB with the same rate of colorectal adenocarcinoma detection. One in three of those with positive FIT had a significant colorectal disease. This supports National Institute of Health and Care Excellence recommendation that FIT can be reliably used as a triage test in primary care without overburdening endoscopy resources.

Moreover, the FIT results should not be taken in isolation, but clinical impressions and the results of other investigations, probably including the full blood count, should be considered. Challenges still exist, however, and harmonisation of aspects of the available FIT analytical systems is required. Moreover, a number of seemingly valid clinical concerns remain and these require resolution through further research and reporting of studies done in real clinical practice.