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Hernández G, Quintero E, Morales-Arraez D, Rayado GG, Hijos-Mallada G, Fernández-Fernández N, de Castro-Parga L, Álvarez-Sánchez MV, Olano C, Rodríguez-Alcalde D, Amaral-González C, Alonso-Abreu I, Nicolás-Pérez D, Carrillo-Palau M, González-Dávila E, Gimeno-García AZ. Development and validation of a faecal immunochemical test-based model in the work-up of patients with iron deficiency anaemia. Front Med (Lausanne) 2024; 11:1407812. [PMID: 38983363 PMCID: PMC11231424 DOI: 10.3389/fmed.2024.1407812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/30/2024] [Indexed: 07/11/2024] Open
Abstract
Objective In patients with iron deficiency anaemia (IDA), the diagnostic yield of gastroscopy and colonoscopy (bidirectional endoscopy) in detecting neoplastic lesions is low. This study aimed to develop and validate a faecal immunochemical test (FIT)-based model to optimise the work-up of patients with IDA. Methods Outpatients with IDA were enrolled in a prospective, multicentre study from April 2016 to October 2019. One FIT was performed before bidirectional endoscopy. Significant gastrointestinal lesions were recorded and a combined model developed with variables that were independently associated with significant colorectal lesions in the multivariate analysis. The model cut-off was selected to provide a sensitivity of at least 95% for colorectal cancer (CRC) detection, and its performance was compared to different FIT cut-offs. The data set was randomly split into two groups (developed and validation cohorts). An online calculator was developed for clinical application. Results The development and validation cohorts included 373 and 160 patients, respectively. The developed model included FIT value, age, and sex. In the development and validation cohorts, a model cut-off of 0.1375 provided a negative predictive value of 98.1 and 96.7% for CRC and 90.7 and 88.3% for significant colorectal lesions, respectively. This combined model reduced the rate of missed significant colorectal lesions compared to FIT alone and could have avoided more than one-fourth of colonoscopies. Conclusion The FIT-based combined model developed in this study may serve as a useful diagnostic tool to triage IDA patients for early endoscopic referral, resulting in considerable reduction of unnecessary colonoscopies.
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Affiliation(s)
- Goretti Hernández
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Enrique Quintero
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
- Departamento de Medicina Interna, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Dalia Morales-Arraez
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | | | | | | | | | - Carolina Olano
- Clínica de Gastroenterología. Facultad de Medicina, Montevideo, Uruguay
| | | | - Carla Amaral-González
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Inmaculada Alonso-Abreu
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - David Nicolás-Pérez
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Marta Carrillo-Palau
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Enrique González-Dávila
- Departamento de Matemáticas, Estadística e Investigación Operativa, Instituto IMAULL, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Antonio Z. Gimeno-García
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
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Rodriguez-Alonso L, Rodriguez-Moranta F, Ruiz-Cerulla A, Arajol C, Serra K, Gilabert P, Ibañez-Sanz G, Camps B, Guardiola J. The use of faecal immunochemical testing in the decision-making process for the endoscopic investigation of iron deficiency anaemia. Clin Chem Lab Med 2021; 58:232-239. [PMID: 31785194 DOI: 10.1515/cclm-2019-0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/17/2019] [Indexed: 12/15/2022]
Abstract
Background Blood loss from the gastrointestinal (GI) tract is the most common cause of iron deficiency anaemia (IDA) in adult men and postmenopausal women. Gastroduodenal endoscopy (GDE) and colonoscopy are frequently recommended, despite uncertainty regarding the coexistence of lesions in the upper and lower GI tract. The faecal immunochemical test (FIT) measures the concentration of faecal haemoglobin (f-Hb) originating only from the colon or rectum. We aimed to assess whether the FIT was able to select the best endoscopic procedure for detecting the cause of IDA. Methods A prospective study of 120 men and postmenopausal women referred for a diagnostic study of IDA were evaluated with an FIT, GDE and colonoscopy. The endoscopic finding of a significant upper lesion (SUL) or a significant bowel lesion (SBL) was considered to be the cause of the IDA. Results The diagnoses were 35.0% SUL and 20.0% SBL, including 13.3% GI cancer. In the multivariate analysis, the concentration of blood haemoglobin (b-Hb) <9 g/dL (OR: 2.60; 95% CI 1.13-6.00; p = 0.025) and non-steroidal anti-inflammatory drugs NSAIDs (2.56; 1.13-5.88; p = 0.024) were associated with an SUL. Age (0.93; 0.88-0.99; p = 0.042) and f-Hb ≥ 15 μg Hb/g faeces (38.53; 8.60-172.50; p < 0.001) were associated with an SBL. A "FIT plus gastroscopy" strategy, in which colonoscopy is performed only when f-Hb ≥15 μg Hb/g faeces, would be able to detect 92.4% of lesions and be 100% accurate in the detection of cancer while avoiding 71.6% of colonoscopies. Conclusions The FIT is an accurate method for selecting the best endoscopy study for the evaluation of IDA. An FIT-based strategy is more cost-effective than the current bidirectional endoscopy-based strategy and could improve endoscopic resource allocation.
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Affiliation(s)
- Lorena Rodriguez-Alonso
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | | | - Alexandra Ruiz-Cerulla
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Claudia Arajol
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Katja Serra
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Pau Gilabert
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Gemma Ibañez-Sanz
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Catalan Institute of Oncology, Cancer Prevention and Control Programme, IDIBELL, Barcelona, Spain
| | - Blau Camps
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Jordi Guardiola
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, Feixa Llarga S/N, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.,Universidad de Barcelona, Barcelona, Spain, Phone: +34 932 607 500x2692/2826, Fax: +34 93 2607883
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