Background
Methods
Study design
Brief description of the COLONPREDICT study
2017 NG12 referral criteria and the f-Hb based prediction models calculation
Criteria | Number of patients (n = 1572) |
---|---|
Patients ≥40 years with unexplained weight loss and abdominal pain | 196 (12.5%) |
Patients ≥50 years with unexplained rectal bleeding | 811 (51.6%) |
Patients ≥60 years with: iron–deficiency anaemia or changes in their bowel habit | 890 (56.7%) |
Patients with a rectal or abdominal mass | 80 (5.1%) |
Adults < 50 years with rectal bleeding and any of the following unexplained symptoms or findings: abdominal pain, change in bowel habit, weight loss or iron-deficiency anaemia. | 124 (7.9%) |
Offer testing for occult blood in faeces to assess for colorectal cancer in adults without rectal bleeding who but with unexplained symptoms that do not meet the criteria for a suspected cancer pathway referral A positive test for occult blood in faeces was considered if the haemoglobin concentration was ≥10 μg Hb/g faeces. | 78 (4.9%) |
Any of the referral criteria | 1479 (94.1%) |
Outcomes
Statistical analysis
Results
Description of the cohort
Analysis of the diagnostic accuracy
Sensititvity1 | P2 | Specificity1 | P3 | Positive PV1 | Negative PV1 | Positive LR4 | Negative LR4 | Diagnostic OR4 | |
---|---|---|---|---|---|---|---|---|---|
2017 NG12 referral criteria (n = 1479) | 100% (97.8–100.0) | 6.8% (5.6–8.4) | 14.5% (12.8–16.5) | 100% (95.0–100.0) | 1.07 (1.06–1.09) | NE | NE | ||
CG27 referral criteria (n = 821) | 68.2% (61.5–74.3) | p < 0.001 | 50.3% (47.6–53.0) | p < 0.001 | 17.8% (15.3–20.6) | 91.0% (89.0–93.0) | 1.4 (1.2–1.5) | 0.6 (0.5–0.8) | 2.2 (1.6–2.9) |
f-Hb ≥ 20 μg Hb/g faeces (n = 607) | 91.2% (86.3–94.4) | p < 0.001 | 69.6% (67.1–72.0) | p < 0.001 | 32.3% (28.6–36.2) | 98.0% (96.9–98.8) | 3.0 (2.7–3.3) | 0.1 (0.08–0.2) | 23.6 (14.5–38.3) |
f-Hb ≥ 10 μg Hb/g faeces (n = 696) | 93.5% (89.1–96.3) | p = 0.001 | 63.4% (60.7–66.0) | p < 0.001 | 28.9% (25.6–32.4) | 98.4 (97.2–99.1) | 2.6 (2.4–2.8) | 0.1 (0.06–0.2) | 24.8 (14.3–43.2) |
COLONPREDICT Score ≥ 5.6 (n = 463) | 90.1% (85.1–93.6) | p < 0.001 | 78.7% (76.4–80.9) | p < 0.001 | 40.7% (36.2–45.3) | 98.0% (96.9–98.7) | 4.2 (3.8–4.7) | 0.1 (0.08–0.2) | 33.8 (21.1–54.0) |
COLONPREDICT Score ≥ 3.2 (n = 994) | 99.5% (97.0–100.0) | 1 | 45.8% (43.1–48.2) | p < 0.001 | 22.9% (20.3–25.8) | 99.8% (98.9–100.0) | 1.8 (1.7–1.9) | 0.01 (0.0–0.07) | 179 (25–1280) |
FAST Score ≥ 4.50 (n = 583) | 89.8% (84.7–93.3) | p < 0.001 | 71.3% (68.8–73.7) | p < 0.001 | 33.2% (29.4–37.2) | 97.8% (96.6–98.6) | 3.13 (2.84–3.44) | 0.14 (0.10–0.21) | 21.8 (13.8–34.4) |
FAST Score ≥ 2.12 (n = 1383) | 100.0% (97.8–100.0) | p = 1 | 13.9% (12.1–15.9) | p < 0.001 | 15.6% (13.7–17.6) | 100% (97.5–100.0) | 1.16 (1.14–1.19) | NE | NE |
Sensititvity1 | P2 | Specificity1 | P3 | Positive PV1 | Negative PV1 | Positive LR4 | Negative LR4 | Diagnostic OR4 | |
---|---|---|---|---|---|---|---|---|---|
2017 NG12 referral criteria (n = 1479) | 98.9% (97.3–99.6) | 7.9% (6.4–9.7) | 30.9% (28.6–33.4) | 94.6% (87.3–98.0) | 1.07 (1.05–1.10) | 0.14 (0.06–0.3) | 7.9 (3.2–19.5) | ||
CG27 referral criteria (n = 821) | 58.3% (53.6–62.8) | p < 0.001 | 50.3% (47.3–53.3) | p < 0.001 | 32.9% (29.7–36.2) | 74.3% (71.0–77.4) | 1.17 (1.07–1.29) | 0.83 (0.73–0.94) | 1.4 (1.1–1.7) |
f-Hb ≥ 20 μg Hb/g faeces (n = 607) | 74.2% (70.0–78.1) | p < 0.001 | 76.1% (73.5–78.6) | p < 0.001 | 56.5% (52.4–60.5) | 87.6% (85.3–89.6) | 3.11 (2.76–3.50) | 0.34 (0.29–0.40) | 9.2 (7.1–11.8) |
f-Hb ≥ 10 μg Hb/g faeces (n = 696) | 79.4% (75.4–83.0) | p < 0.001 | 70.2% (67.4–72.9) | p < 0.001 | 52.7% (49.0–56.5) | 89.1% (86.8–91.0) | 2.67 (2.41–2.95) | 0.29 (0.24–0.35) | 9.1 (7.0–11.8) |
COLONPREDICT Score ≥ 5.6 (n = 463) | 64.2% (59.5–68.5) | p < 0.001 | 83.1% (80.7–85.2) | p < 0.001 | 61.4% (56.9–65.8) | 84.7% (82.3–86.7) | 3.79 (3.27–4.40) | 0.43 (0.38–0.49) | 8.8 (6.8–11.3) |
COLONPREDICT Score ≥ 3.2 (n = 994) | 88.7% (85.3–91.4) | p < 0.001 | 51.3% (48.3–54.3) | p < 0.001 | 43.3% (40.1–46.6) | 91.5% (89.0–93.6) | 1.82 (1.70–1.95) | 0.22 (0.17–0.29) | 8.3 (6.0–11.3) |
FAST Score ≥ 4.50 (n = 583) | 72.7% (68.4–76.7) | p < 0.001 | 77.8% (75.2–80.2) | p < 0.001 | 57.8% (53.7–61.9) | 87.2% (84.9–89.2) | 3.28 (2.90–3.71) | 0.35 (0.30–0.41) | 9.4 (7.3–12.0) |
FAST Score ≥ 2.12 (n = 1383) | 97.8% (95.9–98.9) | p = 1 | 16.1% (14.0–18.4) | p < 0.001 | 32.8% (30.3–35.3) | 94.7% (90.2–97.3) | 1.17 (1.13–1.2) | 0.13 (0.07–0.25) | 8.7 (4.5–16.5) |