Article ; Online: Risk of missing colorectal cancer with a COVID-adapted diagnostic pathway using quantitative faecal immunochemical testing.
BJS open
2021 Volume 5, Issue 4
Abstract: ... COVID-adapted pathway for suspected bowel cancer combines two quantitative faecal immunochemical tests ... Decision-tree models were developed using a combination of data from the COVID-adapted pathway (April-May 2020 ... Results: The COVID-adapted pathway included 422 patients, whereas the audit of qFIT included more ...
Abstract | Background: COVID-19 has brought an unprecedented challenge to healthcare services. The authors' COVID-adapted pathway for suspected bowel cancer combines two quantitative faecal immunochemical tests (qFITs) with a standard CT scan with oral preparation (CT mini-prep). The aim of this study was to estimate the degree of risk mitigation and residual risk of undiagnosed colorectal cancer. Method: Decision-tree models were developed using a combination of data from the COVID-adapted pathway (April-May 2020), a local audit of qFIT for symptomatic patients performed since 2018, relevant data (prevalence of colorectal cancer and sensitivity and specificity of diagnostic tools) obtained from literature and a local cancer data set, and expert opinion for any missing data. The considered diagnostic scenarios included: single qFIT; two qFITs; single qFIT and CT mini-prep; two qFITs and CT mini-prep (enriched pathway). These were compared to the standard diagnostic pathway (colonoscopy or CT virtual colonoscopy (CTVC)). Results: The COVID-adapted pathway included 422 patients, whereas the audit of qFIT included more than 5000 patients. The risk of missing a colorectal cancer, if present, was estimated as high as 20.2 per cent with use of a single qFIT as a triage test. Using both a second qFIT and a CT mini-prep as add-on tests reduced the risk of missed cancer to 6.49 per cent. The trade-off was an increased rate of colonoscopy or CTVC, from 287 for a single qFIT to 418 for the double qFIT and CT mini-prep combination, per 1000 patients. Conclusion: Triage using qFIT alone could lead to a high rate of missed cancers. This may be reduced using CT mini-prep as an add-on test for triage to colonoscopy or CTVC. |
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MeSH term(s) | COVID-19 ; Clinical Audit ; Colonoscopy ; Colorectal Neoplasms/diagnosis ; Decision Trees ; Diagnostic Errors/statistics & numerical data ; Early Detection of Cancer/methods ; Humans ; Occult Blood ; Scotland ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Triage/organization & administration |
Language | English |
Publishing date | 2021-08-24 |
Publishing country | England |
Document type | Journal Article ; Research Support, Non-U.S. Gov't |
ISSN | 2474-9842 |
ISSN (online) | 2474-9842 |
DOI | 10.1093/bjsopen/zrab056 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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