Hamilton William, Sharp Deborah
Division of Primary Health Care, Cotham House, Cotham Hill, Bristol BS6 6JL, UK.
Fam Pract. 2004 Dec;21(6):605-11. doi: 10.1093/fampra/cmh605. Epub 2004 Nov 1.
Lung cancer has the highest cancer incidence and mortality in the UK. Despite this, an individual GP encounters only one new presentation approximately every 8 months, so gains relatively little experience of its diagnosis. This is partly addressed by referral guidelines which aim to help GPs in selection of patients for chest X-ray or referral for specialist investigation.
The purpose of this study was to review the primary care presenting features of lung cancer, in the light of the UK Referral Guidelines for Suspected Cancer.
A structured literature review was carried out.
Little research has been undertaken in primary care, and the predictive values for most symptoms are unknown. Approximate likelihood ratios could be calculated for six symptoms or signs: haemoptysis 13; fatigue 5.7; cough 5.3; finger clubbing 3.9; weight loss 2.9; and dyspnoea 1.5-5.7, but none of these figures derived from single primary care studies. Three recommendations for urgent investigation of possible lung cancer in the UK Referral Guidelines are questioned: for unexplained dyspnoea, hoarseness or cervical lymphadenopathy. For all these presentations, other serious diagnoses are more likely.
The UK Guidelines for referral of suspected lung cancer have a weak evidence base.
在英国，肺癌的发病率和死亡率在各类癌症中最高。尽管如此，一名普通全科医生大约每8个月才会遇到一例新的肺癌病例，因此在肺癌诊断方面积累的经验相对较少。转诊指南在一定程度上解决了这个问题，其目的是帮助全科医生筛选适合进行胸部X光检查或转诊至专科进行进一步检查的患者。
本研究旨在根据英国疑似癌症转诊指南，回顾肺癌在初级医疗中的表现特征。
进行了一项结构化文献综述。
在初级医疗领域开展的相关研究较少，大多数症状的预测价值尚不清楚。可以计算出六种症状或体征的近似似然比：咯血为13；疲劳为5.7；咳嗽为5.3；杵状指为3.9；体重减轻为2.9；呼吸困难为1.5 - 5.7，但这些数据均非来自单一的初级医疗研究。英国转诊指南中关于对可能的肺癌进行紧急检查的三项建议受到质疑：针对不明原因的呼吸困难、声音嘶哑或颈部淋巴结肿大。对于所有这些症状表现，其他严重疾病的诊断更为常见。
英国疑似肺癌转诊指南的证据基础薄弱。
