Poor predictive value of lower gastrointestinal alarm features in the diagnosis of colorectal cancer in 1981 patients in secondary care

Simpkins, Steven; Sánchez, María Inés Pinto; Martin, Paul; Berčík, Přemysl; Morgan, David; Bolino, Carolina; Ford, Alexander C

doi:10.1111/apt.13846

Cited by 12 publications

(18 citation statements)

References 33 publications

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“…All patients were referred to the Digestive Disease Center by physicians at Tianjin Medical University General Hospital. When referring patients for colonoscopy, their GI symptoms were recorded, among which hematochezia, weight loss, anemia, changes in bowel habit, diarrhea, abdominal mass, and melena were considered to be alarming symptoms . Patients' age, sex, initial symptoms and signs, colonoscopic findings, and pathologic diagnosis were documented in the colonoscopy database, which was described previously …”

Section: Methodsmentioning

confidence: 99%

Reevaluation of a rightward shift in colorectal cancer: A single‐center retrospective study in Tianjin

Chen

Liu

et al. 2019

J of Digest Diseases

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Objectives Some Western reports have shown a proximal shift in colorectal cancer (CRC), but there are few studies in China. This study aimed to provide more information for the management and screening of CRC by investigating trends in the anatomic distribution of CRC among the Chinese population in recent years. Methods A retrospective study was conducted on patients with CRC admitted to the Digestive Endoscopy Center of Tianjin Medical University General Hospital between January 2000 and December 2017. Patients were divided into a left‐sided colorectal cancer (LSCRC) group and a right‐sided colon cancer (RSCC) group. The detection rates of LSCRC and RSCC based on patients' age and sex, and on the time periods were analyzed. Results A total of 2319 cases were diagnosed with CRC among 75 183 consecutive patients. The prevalence of CRC showed a significant reduction from 2000‐2008 to 2009‐2017 (3.8% vs 2.7%, P < .001). The proportion of RSCC presented a downtrend from 2000‐2008 to 2009‐2017 (40.6% vs 37.7%, P > .05). There were slightly more RSCCs in female patients than in male patients, with no significant difference (40.9% vs 36.5%, P > .05). The proportion of RSCC in patients aged ≥50 years was similar to that in younger patients. The alarming symptoms between LSCRC and RSCC showed a significant difference (P < .05). Conclusions In the present study, the prevalence of CRC declined significantly with time. However, there did not appear to be a rightward shift in CRC among the patients in Tianjin over the past 18 years.

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Section: Methodsmentioning

confidence: 99%

Reevaluation of a rightward shift in colorectal cancer: A single‐center retrospective study in Tianjin

Chen

Liu

et al. 2019

J of Digest Diseases

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“…The Hamilton Health Sciences and McMaster University Research Ethics Board approved the study in January 2008 and recruitment continued until December 2012. The methodology and study population used has been described in detail elsewhere . We used these patients to derive a latent class model to predict the presence of IBS.…”

Section: Methodsmentioning

confidence: 99%

“…The methodology and study population used has been described in detail elsewhere. 14,[25][26][27][28][29][30][31][32] We used these patients to derive a latent class model to predict the presence of IBS.…”

Section: Participants and Settingsmentioning

confidence: 99%

Derivation and validation of a diagnostic test for irritable bowel syndrome using latent class analysis

Sood

Gracie

Gold

et al. 2017

Aliment Pharmacol Ther

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Summary Background The accuracy of symptom‐based diagnostic criteria for irritable bowel syndrome (IBS) is modest. Aims To derive and validate a new test that utilises latent class analysis. Methods Symptom, colonoscopy, and histology data were collected from 1981 patients and 360 patients in two cohorts referred to secondary care for investigation of their gastrointestinal symptoms in Canada and the UK, respectively. Latent class analysis was used to identify naturally occurring clusters in patient‐reported symptoms in the Canadian dataset, and the latent class model derived from this was then applied to the UK dataset in order to validate it. Sensitivity, specificity, and positive and negative likelihood ratios (LRs) were calculated for the latent class models. Results In the Canadian cohort, the model had a sensitivity of 44.7% (95% CI 40.0–50.0) and a specificity of 85.3% (95% CI 83.4–87.0). Positive and negative LRs were 3.03 (95% CI 2.57–3.56) and 0.65 (95% CI 0.59–0.71) respectively. A maximum positive LR of 3.93 was achieved following construction of a receiver operating characteristic curve. The performance in the UK cohort was similar, with a sensitivity and specificity of 52.5% (95% CI 42.2–62.7) and 84.3% (95% CI 79.3–88.6), respectively. Positive and negative LRs were 3.35 (95% CI 2.38–4.70) and 0.56 (95% CI 0.45–0.68), respectively, with a maximum positive LR of 4.15. Conclusions A diagnostic test for IBS, utilising patient‐reported symptoms incorporated into a latent class model, performs as accurately as symptom‐based criteria. It has potential for improvement via addition of clinical markers, such as coeliac serology and faecal calprotectin.

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“…SIRS, We read with great interest the article by Simpkins et al, 1 reporting the assessment of symptom frequency thresholds and NICE referral criteria for alarm features in the detection of colorectal cancer. This study was based on a large prospective population, which should increase the confidence in their conclusion that the predictive value of lower gastrointestinal alarm features is poor.…”

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confidence: 99%

Letter: NICE referral criteria for lower gastrointestinal alarm features – not ideal but not poor either

Min

Zhao

Jin

et al. 2017

Aliment Pharmacol Ther

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Poor predictive value of lower gastrointestinal alarm features in the diagnosis of colorectal cancer in 1981 patients in secondary care

Abstract: Using higher symptom frequency thresholds for alarm features improved specificity, but sensitivity was low. NICE referral criteria had PPVs above 4.8%, but sensitivities ranged from 2.2% to 32.6%, meaning many cancers would be missed.

Cited by 12 publications

References 33 publications

Reevaluation of a rightward shift in colorectal cancer: A single‐center retrospective study in Tianjin

Reevaluation of a rightward shift in colorectal cancer: A single‐center retrospective study in Tianjin

Derivation and validation of a diagnostic test for irritable bowel syndrome using latent class analysis

Letter: NICE referral criteria for lower gastrointestinal alarm features – not ideal but not poor either

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