Faecal immunochemical testing is the latest advance in the screening programme designed to identify patient with colorectal cancer, but success relies on the quality of the sample, as Matthew Davies explains.
The National Institute for Health and Care Excellence (NICE) NG12 guidelines on cancer recognition and referral were issued in 2015. Now, NICE has reintroduced faecal occult blood tests (FOBTs) back into the diagnostic pathway for those low-risk patients with suspected lower gastrointestinal cancers. This has put a strain on pathology departments to provide a test for the presence of blood in faeces.
This presents a challenge, given that in response to the former 2005 guidelines, many pathology departments discontinued their FOBTs, which were, at that time, the traditional guaiac-based tests (gFOBTs). For some, the decision that now has to be made to satisfy NG12 is which test to implement. Technology has moved on to embrace more analytically and clinically sensitive methods such as the quantitative faecal immunochemical test (FIT) for haemoglobin on systems such as the HM-JACKarc.
The second major challenge has been the logistics of getting a quality sample from the patient to the laboratory for analysis. In part, this depends on the technology to be employed for the detection of faecal haemoglobin (f-Hb). In the days of guaiac-based faecal testing, samples were sent in traditional blue-capped ‘stool pots’. This was clearly wrong, as haemoglobin in native faeces is very unstable.1
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