Schmidt-Hansen Mia, Berendse Sabine, Hamilton William
National Collaborating Centre for Cancer, Park House, Greyfriars Road, Cardiff CF10 3AF and
National Collaborating Centre for Cancer, Park House, Greyfriars Road, Cardiff CF10 3AF and.
Fam Pract. 2015 Dec;32(6):618-23. doi: 10.1093/fampra/cmv075. Epub 2015 Oct 14.
We performed a systematic review of diagnostic studies of symptomatic patients in primary care to quantify the risk of brain/central nervous system (CNS) cancer in patients presenting in primary care with symptoms that may indicate brain/CNS cancer.
To quantify the risk of brain/CNS cancer in symptomatic patients presenting in primary care.
We searched Medline, Premedline, Embase, the Cochrane Library, Web of Science and ISI Proceedings (1980 to August 2014) and PsychInfo (1980 to February 2013) for diagnostic studies of symptomatic adult patients in primary care. Study quality was assessed using QUADAS-II and data were extracted to calculate the positive predictive values (PPVs) of symptoms, singly or in combination, for brain/CNS cancer.
Six studies with 159938 patients were included. The PPVs of single symptoms were very low with only 'new-onset seizure' being above 1% in patients aged 18 years and above, rising to 2.3% in patients aged 60-69 years. In patients aged 15-24 years, the PPVs for the individual symptoms were also very low, with the highest, also for seizure, being 0.024%, similar to that in children aged 0-14 years of 0.02%. For symptom combinations, none of the PPVs were above 0.39%.
All the symptoms of brain tumours are individually low risk, apart from new-onset epilepsy. This provides a real diagnostic problem, as brain tumours have all the expected features seen with cancer diagnostic delay, with high proportions presenting as an emergency and having had multiple primary care consultations before referral, and the prognosis is poor. Improving these metrics can only be done by liberalizing investigation, although the health economics of that strategy is undetermined.
我们对基层医疗中有症状患者的诊断研究进行了系统综述，以量化在基层医疗中出现可能提示脑/中枢神经系统（CNS）癌症症状的患者患脑/CNS癌症的风险。
量化在基层医疗中出现症状的患者患脑/CNS癌症的风险。
我们检索了Medline、Premedline、Embase、Cochrane图书馆、科学引文索引和ISI会议录（1980年至2014年8月）以及PsychInfo（1980年至2013年2月），以查找关于基层医疗中有症状成年患者的诊断研究。使用QUADAS-II评估研究质量，并提取数据以计算单个或组合症状对脑/CNS癌症的阳性预测值（PPV）。
纳入了6项研究，共159938例患者。单个症状的PPV非常低，仅“新发癫痫”在18岁及以上患者中高于1%，在60 - 69岁患者中升至2.3%。在15 - 24岁患者中，单个症状的PPV也非常低，最高的也是癫痫，为0.024%，与0 - 14岁儿童的0.02%相似。对于症状组合，没有一个PPV高于0.39%。
除新发癫痫外，脑肿瘤的所有症状个体风险都很低。这带来了一个实际的诊断问题，因为脑肿瘤具有癌症诊断延迟的所有预期特征，很大比例的患者以急诊形式就诊，在转诊前已多次接受基层医疗咨询，且预后较差。只有通过放宽检查才能改善这些指标，尽管该策略的卫生经济学尚不确定。
