ORIGINAL RESEARCH article
Front. Gastroenterol.
Sec. Gastroenterology and Cancer
Volume 4 - 2025 | doi: 10.3389/fgstr.2025.1622258
Faecal Immunochemical Test to triage patients with possible colorectal cancer symptoms: Insights from The New Zealand FIT for Symptomatic Pilot
Provisionally accepted
- 1The University of Auckland, Auckland, New Zealand
- 2Health New Zealand Waikato District, Hamilton, New Zealand
- 3National Public Health Service - Health New Zealand., Wellington, New Zealand
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ABSTRACT BACKGROUND The New Zealand (NZ) FIT for Symptomatic Pilot (FSP) aimed to determine the feasibility of using faecal immunochemical test (FIT) as a triaging tool to assess patients presenting with symptoms suspicious for colorectal cancer (CRC). METHODS This is a double blinded diagnostic accuracy study conducted in two Health NZ Districts from July 2022 to January 2024. Consecutive adult patients referred with symptoms of suspected CRC, who were triaged for colonoscopy by endoscopists, were invited to perform a quantitative FIT The diagnostic performance of FIT for CRC was assessed. RESULTS Valid FIT results were returned by 1158 (82%) of 1413 eligible patients, 1043 were included in diagnostic accuracy analysis. At low ("rule-out") faecal haemoglobin (f-Hb) thresholds, the sensitivity and specificity for CRC were 93.8%(CI 79.2 - 99.2), 75.9%(CI 73.1 - 78.5) for f-Hb≥4 µg/g and 90.6%(CI 75.0 - 98.0), 83.1%(CI 80.6 - 85.4) for f-Hb≥10 µg/g. At higher ("rule-in") f-Hb threshold of ≥150 µg/g, sensitivity and specificity for CRC were 78.1%(CI 60.0 - 90.7) and 95.9% (CI 94.4 - 97.0). Prevalence of CRC was 3.1%. At lower limit of f-Hb detection, 73.7% of symptomatic patients had a negative FIT. CONCLUSION FSP demonstrated that FIT identified both a small group of symptomatic patients with high risk of undiagnosed CRC for urgent investigation and the majority of symptomatic patients with a very low f-Hb who could avoid colonoscopy. Using FIT in this setting should protect patients from unnecessary colonoscopy, diagnose CRC earlier and optimise colonoscopy utilization.
Keywords: Colorectal Neoplasms / diagnosis*, Occult Blood*, Triage / methods*, Faeces / chemistry, Hemoglobins / analysis, Immunochemistry*
Received: 02 May 2025; Accepted: 01 Sep 2025.
Copyright: © 2025 Saw, Ngatai, Whiteside, Parry and Bissett. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ian Bissett, The University of Auckland, Auckland, New Zealand
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