Gao C, Qin C, Freeman S, Oskooee N, Hughes J
UCL Medical School, London, UK.
Department of General Surgery, Peterborough City Hospital, Northwest Anglia NHS Foundation Trust, UK.
J Laryngol Otol. 2019 Aug;133(8):704-712. doi: 10.1017/S002221511900149X. Epub 2019 Aug 2.
The National Institute for Health and Care Excellence referral guidelines prompting urgent two-week referrals were updated in 2015. Additional symptoms with a lower threshold of 3 per cent positive predictive values were integrated. This study aimed to examine whether current pan-London urgent referral guidelines for suspected head and neck cancer lead to efficient and accurate referrals by assessing frequency of presenting symptoms and risk factors, and examining their correlation with positive cancer diagnoses.
The risk factors and symptoms of 984 consecutive patients (over a six-month period in 2016) were collected retrospectively from urgent referral letters to University College London Hospital for suspected head and neck cancer.
Only 37 referrals (3.76 per cent) resulted in a head and neck cancer diagnosis. Four of the 23 recommended symptoms demonstrated statistically significant results. Nine of the 23 symptoms had a positive predictive value of over 3 per cent.
The findings indicate that the current referral guidelines are not effective at detecting patients with cancer. Detection rates have decreased from 10-15 per cent to 3.76 per cent. A review of the current head and neck cancer referral guidelines is recommended, along with further data collection for comparison.
英国国家卫生与临床优化研究所（National Institute for Health and Care Excellence）关于促使进行紧急两周转诊的指南于2015年进行了更新。纳入了阳性预测值阈值较低（3%）的其他症状。本研究旨在通过评估症状出现频率和风险因素，并检查它们与癌症阳性诊断的相关性，来检验当前伦敦地区针对疑似头颈癌的紧急转诊指南是否能实现高效且准确的转诊。
回顾性收集了2016年六个月期间连续984例因疑似头颈癌向伦敦大学学院医院进行紧急转诊的患者的风险因素和症状，这些信息来自紧急转诊信函。
只有37例转诊（3.76%）被诊断为头颈癌。23种推荐症状中有4种显示出具有统计学意义的结果。23种症状中有9种的阳性预测值超过3%。
研究结果表明，当前的转诊指南在检测癌症患者方面效果不佳。检出率已从10% - 15%降至3.76%。建议对当前的头颈癌转诊指南进行审查，并进一步收集数据以作比较。
