NICE Guidance

An article published in PULSE outlining the possible changes to the NICE guidelines regarding FIT in Primary Care. “NICE has recommended that GPs use FIT tests to triage all patients with signs or symptoms of colorectal cancer in a bid to reduce colonoscopy waiting times. In draft guidance that has been released for consultation today, NICE said that people with results > 10 µg of haemoglobin in their faeces should be referred on for further investigation.

Our survey findings suggest that GPs’ awareness of using FIT as a triage test in primary care is currently low and there is limited insight into the perceived barriers and facilitators associated with GPs’ use of the test. Successful early adoption of the FIT test in primary care will require extensive primary care engagement to raise awareness of the NICE guideline and the updated diagnostics guidance in parallel with providing access to the FIT test.

Our aim was to compare the utility of f-Hb as the initial investigation with the NICE NG12 symptom-based guidelines. F-Hb provides a good rule-out test for SCD and has significantly higher overall diagnostic accuracy than NG12.

1.1 […] recommended for adoption in primary care to guide referral for suspected colorectal cancer in people without rectal bleeding who have unexplained symptoms but do not meet the criteria for a suspected cancer pathway referral outlined in NICE’s guideline on suspected cancer (recommendations 1.3.1 to 1.3.3).

1.2 Results should be reported using a threshold of 10 micrograms of haemoglobin per gram of faeces.

Section 1.3 Lower Gastrointestinal tract cancers

This study has attempted to assess the effectiveness of quantitative faecal immunochemical tests (FIT) for triage of people presenting with lower abdominal symptoms, where a referral to secondary care for investigation of suspected colorectal cancer (CRC) is being considered, particularly when the 2-week criteria are not met. There is evidence to suggest that triage using FIT at a cut-off around 10 μg Hb/g faeces has the potential to correctly rule out CRC and avoid colonoscopy in 75-80% of symptomatic patients.

Reporting of results should be done using µg Hb/g faeces units and with knowledge of the limit of detection and limit of quantitation of the analytical system used. FIT can be used successfully in an agreed diagnostic pathway, along with other clinical and laboratory information: this requires a multidisciplinary approach, providing opportunities for professionals in laboratory medicine involvement.