A combination guaiac and immunological test Fecatwin/Feca EIA for the detection of faecal occult blood was used in the investigation of 535 symptomatic patients in order to assess the value of this combined test in the detection of colorectal neoplasia. The addition of the immunological part of the test led to an improvement in specificity for colorectal cancer from 80% to 91% and an increase in the positive predictive value of the test for colorectal cancer from 14% to 24%. However, there was a fall in sensitivity from 75% to 67%. There was no substantial advantage in the addition of the immunological part of the test to justify the extra laboratory workload incurred.