HM-JACKarc References


HM-JACKarc References

Clinical Utility of HM-JACKarc for the Detection of Colorectal Cancer and High Risk Adenomas

This presentation, from the World Endoscopy Organisation, is regarding the use of FIT in triaging symptomatic patients, and discusses the various instruments currently available on the market. Focusing on the effectiveness of the HM-JACKarc in evaluating symptomatic patients, the author discusses the uses of the instrument in the screening market. Further outlining the use of FIT in screening programmes, the HM-JACKarc’s low-end sensitivity is described as ‘very useful’ as a rule out test for CRC.

 Fradera, J. M. A. (2015) The Performance of FIT to triage symptomatic patients. World Endoscopy Organisation, Colorectal Cancer Screening Committee. Barcelona 23 Oct 2015 
Evaluation of quantitative faecal immunochemical tests for haemoglobin

From the perspective of the testing laboratory, this comprehensive study by the NHS Bowel Cancer Screening Southern Hub, compares and contrasts four FIT analysers and their potential applications in CRC screening. The paper examines attributes including; analytical sensitivity, carryover, imprecision, precision profile, linearity, hook/prozone effect, and sample stability, across the range of analysers. The HM-JACKarc compares favourably in many tests; ease of use, sample and reagent stability, operational performance and precision profile.

 Carroll M. et al (2014) NHS Bowel Cancer Screening Southern Hub – Guildford Medical Device Evaluation Centre 
Faecal haemoglobin concentrations vary with sex and age but data are not transferrable across geography for colorectal cancer screening

This study into the effects of sex and age against f-Hb levels concludes that it would be ill-advised to standardise one cut-off value for the entire population when using FIT. Studies in three locations, Scotland, Taiwan, and Italy, where the patients were grouped by age and by sex, indicate that individualisation would be vital to running and maintaining a screening programme beneficial to a whole population.

 Chen, H., Chen, L., Fraser, C., Rapi, S., Rubeca, T. (2014) Clinical Chemistry and Laboratory Medicine. Vol. 52, no. 8, pp. 1211-1216. [online]
Low faecal haemoglobin concentration potentially rules out significant colorectal disease

This paper highlights the importance of the very high negative predictive value (NPV) of FIT and the application of this in symptomatic patients. Based on continuing research into the effects of calprotectin as a rule-out test, this paper focuses on the importance of the NPV value and ruling out SBD, and not limiting it to the detection of CRC. Using a cut-off faecal Hb concentration of 50 ng Hb/ml (10 µg g-1) buffer, NPV of 100.0%, 94.4%, 93.4% and 93.9% were found for; CRC, HRA, LRA, and IBD respectively.

 McDonald, P.J., Digby, J., Innes, C., Strachan, J.A., Carey, F.A., Steele, R.C.J., and Fraser, C.J. (2013) Colorectal Disease. Vol. 15, no. 3, pp.151-159. [online]
Overall evaluation of an immunological latex agglutination system for fecal occult blood testing in the colorectal cancer screening program of Florence

A study into the cost implications of using FIT over FOBT in a screening programme undertaken in Italy. The report outlines the effectiveness of the HM-JACKarc in identifying low-end levels of f-Hb and the impact this could have on already overstretched endoscopy services. This investigation outlines the importance of low-end sensitivity for the diagnosis of CRC and SBD.

 Confortini, M., Peruzzi, B., Rapi, S., Rubeca, T. (2012) International Journal of Biological Markers, vol. 27, no. 3, pp 195-202. [Online] 
Evaluation of the Extel “Hemo Auto” HS and the Hemo Auto MC Feces Collection Container Using the HM-JACKarc Fully Automated Fecal Occult Human Hemoglobin Analyzer

A comprehensive study into the various components of the HM-JACKarc analyser. They conclude that the Extel “Hemo Auto” HS used for the latex agglutination method […] has increased reproducibility.

 Itoh M. et al (2011) Journal of Clinical Laboratory Instruments and Reagents, Vol. 34, No. 3, pp. 387-392
Comparison of fecal occult blood assay by four companies

When using the cut-off value for the clinical sensitivity and specificity recommended with each reagent kit, we did not find any major differences for the different assay methods. The sensitivities of the different methods were compared on the broad distinction between early and progressive cancer. The result for early cancer was 17 – 50% and for progressive cancer 83 – 92%. Thus there was a marked difference between the two.

Nakayasu S. et al (2016) Matsuda Hospital


Studies on “HM-JACK” for Fecal Occult Blood Test Analyzer

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.

 Nara Y. et al (1999) Kiki Shiyaku (Instrument Reagent)

Sampling / Pre-Analytics

Detection Capability of Faecal Haemoglobin Examinations

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.

Fraser C., Benton S., (2018) Presentation from United European Gastroenterology (UEG) week, Vienna
Does the mass of sample loaded affect faecal haemoglobin concentration using the faecal immunochemical test?

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

Piggott C. et al. (2018) Annals of Clinical Biochemistry. Vol. 55, no. 6, pp. 702-705
An assessment of the effect of haemoglobin variants on detection by faecal immunochemical tests

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.

 Carroll M. et al. (2018). Annals of Clinical Biochemistry. Vol. 55, no. 06, pp. 706-709
Clinical utility of one versus two faecal samples in the detection of advanced colorectal neoplasia in symptomatic patients

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.

 Auge, J.M., Castells, A., Fraser, C., Grau, J., Jimenez, W., Lopez-Ceron, M., Rodriguez, C., Roset, R. (2016) Clinical Chemistry and Laboratory Medicine. Vol. 54, no. 1, pp. 125-132. [online]
Impact of preanalytical factors on fecal immunochemical tests: need for new strategies in comparison of methods

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.

 Cellai, F., Confortini, M., Fraser, C., Rapi, S., Rubeca, T. (2015). The International Journal of Biological Markers. Vol. 30, no. 3, pp. 269-345. [online]

FIT & Adjunct Tests

Risk stratification of Symptomatic Patients Suspected of Colorectal Cancer using Faecal and Urinary Markers

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.

 Widlak, M. et al. (2018) Colorectal Disease

Patient Pathways

Experience of adopting faecal immunochemical testing to meet the NICE colorectal cancer referral criteria for low-risk symptomatic primary care patients in Oxfordshire, UK

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.

 Nicholson BD, et al. (2018) Frontline Gastroenterology
Faecal immunochemical tests (FIT) in the assessment of patents presenting with lower bowel symptoms: Concepts and challenges.

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.

Fraser CG. (2018) The Surgeon, Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland. Vol. 16, pp 302-308