Primrose Breast Care Centre, Derriford Hospital, University Hospitals Plymouth NHS Trust, UK.
BJS Open. 2021 Mar 5;5(2). doi: 10.1093/bjsopen/zraa023.
The urgent 2-week wait referral for suspected breast cancer system (U2WW) in the UK prioritizes primary care referrals to one-stop breast clinics as 'urgent' or 'choose and book' (C&B). The aim of this study was to evaluate the accuracy of U2WW in discriminating cancer versus no cancer, and to consider alternative criteria.
Clinical features elicited in primary care and demographics of consecutive female patients in a specialist breast clinic were collated at the time of consultation from May 2008 to July 2017. U2WW was compared with patient age alone and a multivariable model in terms of accuracy and net cost for eight underlying cost-benefit assumptions.
There were 7915 eligible referrals: 4877 urgent (61.6 per cent) and 3038 C&B (38.4 per cent) referrals. Breast cancer was diagnosed in 546 patients (6.9 per cent): 491 (10.1 per cent) in urgent and 55 (1.8 per cent) in C&B referrals (P < 0.001). The multivariable model summated the significant variables: age (odds ratio (OR) 1.07, 95 per cent c.i. 1.07 to 1.08), tumour (OR 4.85, 3.62 to 6.52), observed change (OR 1.73, 1.34 to 2.23), pain (OR 0.46, 0.35 to 0.61) and gravidity (OR 0.72, 0.54 to 0.95). The area under the curve was 0.651 for U2WW, 0.784 for age alone, and 0.824 for the multivariable model (P <0.001 for all comparisons). Considering the cost assumptions, age alone and the multivariable model were either more accurate than U2WW, or as accurate but less costly.
The U2WW is surpassed by patient age as a single referral criterion. A multivariable model based on demographics and simple clinical features outperformed both. The continued use of the U2WW needs to be reconsidered.
英国的两周紧急就诊预约系统（U2WW）将疑似乳腺癌的初级保健转诊分为“紧急”或“选择和预约”（C&B）。本研究旨在评估 U2WW 区分癌症与非癌症的准确性，并考虑替代标准。
2008 年 5 月至 2017 年 7 月，在专家乳腺诊所就诊时，连续收集女性患者的临床特征和人口统计学数据。根据 8 种潜在成本效益假设，U2WW 与患者年龄单独和多变量模型在准确性和净成本方面进行了比较。
共有 7915 例合格转诊：4877 例紧急（61.6%）和 3038 例 C&B（38.4%）转诊。546 例患者诊断为乳腺癌（6.9%）：紧急转诊 491 例（10.1%），C&B 转诊 55 例（1.8%）（P<0.001）。多变量模型汇总了显著变量：年龄（比值比（OR）1.07，95%置信区间（CI）1.07 至 1.08）、肿瘤（OR 4.85，3.62 至 6.52）、观察到的变化（OR 1.73，1.34 至 2.23）、疼痛（OR 0.46，0.35 至 0.61）和生育能力（OR 0.72，0.54 至 0.95）。U2WW 的曲线下面积为 0.651，年龄单独的曲线下面积为 0.784，多变量模型的曲线下面积为 0.824（所有比较均 P<0.001）。考虑到成本假设，年龄单独和多变量模型要么比 U2WW 更准确，要么同样准确但成本更低。
U2WW 作为单一转诊标准被患者年龄所超越。基于人口统计学和简单临床特征的多变量模型表现优于两者。需要重新考虑继续使用 U2WW。
