Faecal haemoglobin concentration is related to severity of colorectal neoplasia.

Abstract

AIMS:

Guaiac faecal occult blood tests are being replaced by faecal immunochemical tests (FIT). We investigated whether faecal haemoglobin concentration (f-Hb) was related to stage in progression of colorectal neoplasia, studying cancer and adenoma characteristics in an evaluation of quantitative FIT as a first-line screening test.

METHODS:

We invited 66 225 individuals aged 50-74 years to provide one sample of faeces. f-Hb was measured on samples from 38 720 responders. Colonoscopy findings and pathology data were collected on the 943 with f-Hb ≥ 400 ng Hb/ml (80 µg Hb/g faeces).

RESULTS:

Of the 814 participants with outcome data (median age: 63 years, range 50-75, 56.4% male), 39 had cancer, 190 high-risk adenoma (HRA, defined as ≥ 3 or any ≥ 10 mm) and 119 low-risk adenoma (LRA). 74.4% of those with cancer had f-Hb>1000 ng Hb/ml compared with 58.4% with HRA, and 44.1% with no pathology. Median f-Hb concentration was higher in those with cancer than those with no (p<0.002) or non-neoplastic (p<0.002) pathology, and those with LRA (p=0.0001). Polyp cancers had lower concentrations than more advanced stage cancers (p<0.04). Higher f-Hb was also found in those with HRA than with LRA (p<0.006), large (>10 mm) compared with small adenoma (p<0.0001), and also an adenoma displaying high-grade dysplasia compared with low-grade dysplasia (p<0.009).

CONCLUSIONS:

f-Hb is related to severity of colorectal neoplastic disease. This has ramifications for the selection of the appropriate cut-off concentration adopted for bowel screening programmes.

• Authors: Jayne Digby, Callum G Fraser, Francis A Carey, Paula J McDonald, Judith A Strachan, Robert H Diament, Margaret Balsitis, Robert J C Steele
• Journal: Journal of clinical pathology (J Clin Pathol) Vol. 66 Issue 5 Pg. 415-9 (May 2013) ISSN: 1472-4146 [Electronic] England
• PMID: 23418340 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Hemoglobins

Topics

• Adult
• Aged
• Colorectal Neoplasms (diagnosis)
• Feces (chemistry)
• Female
• Hemoglobins (analysis)
• Humans
• Immunohistochemistry
• Male
• Mass Screening (methods)
• Middle Aged
• Sensitivity and Specificity