Dr Kapoor and colleagues from Liverpool, England designed a study in order to determine the value of individual alarm features for predicting cancer in subjects referred to a rapid access upper gastrointestinal cancer service.
In addition, the researchers aimed to develop a clinical prediction model for cancer and to prospectively validate this model in a further patient cohort.
The research team prospectively recorded patient demographics, referral indications, and subsequent diagnosis.
The researchers used logistic regression analyses to determine the predictive value of individual alarm features in an evaluation cohort of 1852 consecutive cases.
The team then examined the potential impact of applying a modified set of referral criteria in a validation cohort of 1785 patients.
The researchers noted that in the evaluation cohort, the mean age was 59 years; cancer prevalence 3.8%; and serious benign pathology 12.8%.
|Uncomplicated dyspepsia in those over 55 years was a negative predictive factor for cancer|
The investigators found that dysphagia, weight loss, and age >55 years were significant predictive factors for cancer but the value of other accepted alarm features was more limited.
In particular, uncomplicated dyspepsia in those over 55 years was a negative predictive factor for cancer within this high risk cohort.
The clinical prediction model would have selected 92% of cancer patients for fast track investigation while reducing the "two week rule" workload by 572 cases (31%).
The researchers found that fast track endoscopy in subjects fulfilling current criteria for suspected upper gastrointestinal malignancy results in a significant yield of cancer (4%).
In addition there was a 13% yield of serious benign diseases such as peptic ulceration, strictures, and severe esophagitis.
However, the predictive value of individual features for cancer varies widely.
The team noted that uncomplicated dyspepsia in older subjects was a poor predictor of cancer.
Dr Kapoor concluded, "Application of narrower referral criteria for accessing fast track services may reduce pressures while retaining high sensitivity for cancer."