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Abstract Aim Faecal immunochemical testing (FIT) is a non-invasive screening tool used to aid the detection of colorectal cancers (CRC) by measuring microscopic levels of blood in the stool. The symptomatic threshold is recommended as ≥10μg Hb/g. The use of FIT alongside red flag symptoms provides a higher positive predictive value for diagnosing CRC. We aim to identify delays in the diagnosis and treatment in false negative FIT patients and to improve the pathways of urgent suspected CRCs. Method A prospective cohort of CRC 439 patients under Hywel Dda University Health Board multidisciplinary team (MDT) was reviewed. Exclusion criteria consisted of patients with anorectal mass, anal ulceration or emergency presentation. Data were collected and analysed to appraise the referral process, FIT timing and results, clinical, pathological and oncological outcomes. Results A total of 366 patients (175F:191M) were analysed. There was a false negative rate of 3.8% (n=14). The mean time taken from FIT to diagnosis for these patients was 53.9 days. The main subsequent diagnostic modality was CT (n=10). The average times taken from referral to the first diagnostic modalities (CT colonography and Endoscopy) were 51.6 days and 106 days respectively. Conclusions This study examined the clinical and oncological consequences of false-negative FIT results in CRC patients. It highlighted the need for expert clinical judgment through MDT input and complementary diagnostic modalities to minimize diagnostic delays and improve patient outcomes. This analysis has helped improve referral pathways in a single centre MDT for urgent suspected CRCs.
Louden et al. (Mon,) studied this question.