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FIT (Fecal Immunochemical Test) - Quantitative, Stool

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Stool test for occult blood.

₹4,351₹6,216

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FIT (Fecal Immunochemical Test) - Quantitative Stool

  • Why is it done?
    • Test Purpose: The FIT test detects the presence of occult (hidden) blood in stool by using antibodies specific to human hemoglobin. It is a quantitative test, meaning it measures the actual amount of hemoglobin present rather than just indicating presence or absence.
    • Colorectal Cancer Screening: Primary indication as a non-invasive screening tool for colorectal cancer in average-risk adults aged 45-50 years and older. May be used starting at age 40 in those with family history of colorectal cancer.
    • Detection of Precancerous Lesions: Helps identify adenomatous polyps and other precancerous conditions of the colon and rectum.
    • Evaluation of Lower GI Symptoms: Used in patients with symptoms such as blood in stool, changes in bowel habits, chronic diarrhea, or abdominal pain to investigate potential gastrointestinal bleeding.
    • Anemia Investigation: Assists in identifying occult bleeding as a cause of iron-deficiency anemia when the source is unclear.
    • Monitoring After Polyp Removal: Annual screening intervals following colonoscopy with polyp removal to detect recurrence or new lesions.
    • Typical Screening Schedule: Recommended annually or as directed by physician based on results and risk factors.
  • Normal Range
    • Negative Result: Fecal hemoglobin < 100 ng/mL (nanograms per milliliter) or below laboratory cutoff threshold. This indicates no detectable occult blood in the stool sample.
    • Positive Result: Fecal hemoglobin ≥ 100 ng/mL (specific threshold varies by laboratory). Indicates presence of blood in stool that warrants further investigation.
    • Units of Measurement: Nanograms per milliliter (ng/mL) or micrograms hemoglobin per gram of stool. Some laboratories report as μg Hb/g stool.
    • Interpretation of Results: The quantitative nature of this test allows differentiation between minimal and significant bleeding. Higher hemoglobin levels suggest more bleeding and may indicate more serious pathology.
    • What Normal Means: No occult blood detected; low probability of significant colorectal pathology, though does not completely rule out disease. Repeat screening in 1 year recommended.
    • What Abnormal Means: Occult blood present in stool; indicates need for further diagnostic evaluation such as colonoscopy to identify source of bleeding.
  • Interpretation
    • Negative FIT Results: Suggests absence of significant occult bleeding; reduces but does not eliminate risk of colorectal cancer or polyps. Small adenomas may not bleed enough to be detected. Negative results should lead to continued screening in 1 year.
    • Positive FIT Results: Indicates presence of blood in stool; strongly recommends colonoscopy to visualize the colon and identify source. Positive results are found in approximately 3-5% of screening populations.
    • Hemoglobin Level Significance: Lower positive values (100-200 ng/mL) may indicate minor bleeding sources; higher values (>200 ng/mL) may suggest more significant pathology including cancer or larger polyps.
    • Factors Affecting Test Accuracy: FIT is specific to human hemoglobin, reducing false positives from dietary sources. Sensitivity varies: approximately 75-90% for colorectal cancer and 20-40% for adenomas depending on size and bleeding tendency of lesion.
    • Intermittent Bleeding: Some lesions bleed intermittently; a single negative FIT does not exclude disease. This is why annual testing is recommended.
    • Quantitative Advantage: Provides numerical data allowing risk stratification and comparison with laboratory thresholds; may guide urgency of follow-up investigations.
    • Clinical Context: Results must be interpreted alongside patient symptoms, age, family history, and other risk factors. Symptoms of bleeding warrant further evaluation regardless of FIT results.
  • Associated Organs
    • Primary Organs: Colon, rectum, and lower gastrointestinal tract. Secondary involvement of small intestine, stomach, and upper GI tract possible.
    • Colorectal Cancer: FIT is most specific for detection of malignant neoplasms of the colon and rectum. Positive results warrant urgent colonoscopy to rule out malignancy.
    • Adenomatous Polyps: Detectable polyps, particularly those ≥1 cm. Sensitivity for polyp detection increases with polyp size and histologic type.
    • Diverticular Disease: Bleeding diverticula, particularly in elderly patients, can result in positive FIT. Colonoscopy helps differentiate from cancer.
    • Inflammatory Bowel Disease: Ulcerative colitis and Crohn's disease can cause positive FIT results. These patients have increased colorectal cancer risk and may benefit from enhanced surveillance.
    • Hemorrhoids: Internal hemorrhoids may cause positive FIT; however, external hemorrhoids typically do not bleed into stool enough to be detected. Colonoscopy still needed to exclude other pathology.
    • Gastrointestinal Infections: Bacterial or parasitic infections causing mucosal damage may produce positive results. Repeat testing after resolution of infection may be recommended.
    • Peptic Ulcer Disease: Bleeding gastric or duodenal ulcers may result in positive FIT, particularly if they bleed into the lower GI tract or produce small bowel bleeding.
    • Complications of Positive Results: Delayed diagnosis of colorectal cancer if positive results are not followed up with colonoscopy; risk of complications from undiagnosed bleeding including anemia, hemodynamic instability in severe cases.
  • Follow-up Tests
    • Colonoscopy (Primary Follow-up for Positive Results): Direct visualization of entire colon and rectum to identify source of bleeding. Should be performed within 3-6 months of positive FIT result. Allows for biopsy and polypectomy if needed.
    • Complete Blood Count (CBC): To evaluate for anemia and assess hemoglobin levels, hematocrit, and red cell indices. Particularly important if positive FIT suggests chronic bleeding.
    • Iron Studies: Serum ferritin, iron, and transferrin saturation to assess for iron deficiency anemia that may indicate chronic occult GI bleeding.
    • Repeat FIT Testing (For Negative Results): Annual repeat screening in average-risk individuals with negative results. Some lesions bleed intermittently, and annual testing improves detection rates.
    • Flexible Sigmoidoscopy: Alternative or additional investigation to examine lower colon if full colonoscopy is contraindicated or incomplete.
    • CT Colonography (Virtual Colonoscopy): Alternative imaging study if optical colonoscopy cannot be performed or is contraindicated; useful for detecting polyps and masses.
    • Upper Endoscopy (EGD): May be considered if colonoscopy findings are negative but significant bleeding is evident, to evaluate upper GI sources of blood.
    • Video Capsule Endoscopy: To visualize small bowel if bleeding source not identified by upper endoscopy or colonoscopy.
    • Follow-up Colonoscopy Schedule: After normal colonoscopy following positive FIT: repeat in 10 years if no findings. After polyp removal: 3-5 years for advanced adenomas or 5-10 years for small adenomas depending on findings.
  • Fasting Required?
    • Fasting Requirement: No - Fasting is NOT required for FIT testing. This test is based on stool collection and not blood analysis.
    • Sample Collection Instructions: Collect stool sample in provided collection kit or container. Most labs provide three test tubes that require samples from different areas of the stool to improve detection accuracy.
    • Timing of Collection: Collect samples on different days (typically 3 consecutive days) as some lesions bleed intermittently. This increases sensitivity of detection.
    • Medications to Avoid: No specific medications must be withheld. However, NSAIDs and aspirin may increase false positives by causing minor GI bleeding. Consult physician if taking these regularly.
    • Dietary Restrictions: No dietary restrictions are necessary. FIT is specific to human hemoglobin and not affected by dietary peroxidase from red meat or other food sources as with older guaiac-based tests.
    • Bowel Preparation: No bowel prep or laxatives needed before collection. However, if patient has diarrhea, wait 2-3 days for normalization if possible.
    • Menstrual Cycle Consideration: Women should avoid collecting samples during menstruation if possible, as vaginal bleeding may contaminate sample and cause false positive results.
    • Specimen Transport and Storage: Samples should be placed in preservative solution provided in the collection kit immediately after collection. Return samples to lab within 24-48 hours of collection; refrigerate if longer storage needed.
    • Additional Patient Instructions: Ensure sample is not contaminated with urine or toilet water. Samples must be collected before any medication suppositories or enemas are used. Follow specific laboratory instructions provided with collection kit.

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