A standard for Faecal Immunochemical TesTs for Haemoglobin Evaluation Reporting (FITTER)

There is much current and ever-growing interest in using faecal tests to screen for colorectal cancer, a major health concern in many countries. ¹ Faecal immunochemical tests for haemoglobin (FIT) ² are widely recommended for asymptomatic population screening ³ and have considerable potential for use in other clinical situations. ⁴

There are many publications of different types concerning FIT. These have appeared in a variety of journals and other media. Most document the major clinical findings and outcomes in detail, but adequate descriptions of the pre-analytical aspects (specimen collection, handling and storage prior to analysis) and the analytical performance characteristics attained are very often deficient or simply missing. Such a situation is also found in publications on many other biomarkers. However, in order to evaluate published data, compare and contrast the results of published studies and translate published results into practice, these pre-analytical and analytical aspects need to be adequately described and documented.

The Expert Working Group (EWG) on FIT for Screening, which was formed by the Colorectal Cancer Screening Committee of the World Endoscopy Organization, has a broad remit to improve all aspects of FIT and has produced a number of informative discussion documents and publications (www.worldendo.org/weo-crcsc-expert-working-group-fit-for-screening.html). We recognized the importance of improving published papers on FIT and have now produced a standard for adequate reporting of FIT studies. This involves, as is the case for other such standards, a checklist. The checklist details items to be documented in any publication describing the use of FIT. This requires data on specimen collection and handling (10 items), analysis (5 items), quality management (4 items) and result handling (4 items). The standard and checklist are available at: www.worldendo.org/assets/downloads/pdf/activities/weo_expert_working_group_fit_discussion_doc_no5_pu.pdf

We recommend that investigators and authors adhere to the FITTER standards and use the checklist provided. We advocate that reviewers of submitted manuscripts on FIT request adherence to the standards and look for inclusion of a completed checklist. We also hope that the editors of medical journals and editorial staff will appreciate the value of good documentation of studies on FIT and request authors make the checklist available to all readers. Professionals working in laboratory medicine are well placed to help clinical investigators provide pertinent analytical information required in the FITTER standard and checklist. ⁵