Department of Family and Community Medicine, Department of Health Data Science, Yokohama Hodogaya Central Hospital, Japan Community Healthcare Organization, Yokohama City University, Yokohama, Japan.
Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
BMJ Open. 2023 Aug 11;13(8):e068549. doi: 10.1136/bmjopen-2022-068549.
Diagnostic delay in cancer is a challenge in primary care. Although screening tests are effective in diagnosing some cancers such as breast, colorectal and cervical cancers, symptom-based cancer diagnosis is often difficult due to its low incidence in primary care and the influence of patient anxiety, doctor-patient relationship and psychosocial context. A general practitioner's gut feeling for cancer may play a role in the early diagnosis of cancer in primary care where diagnostic resources are limited. The aim of this study is to summarise existing evidence about the test accuracy of gut feeling (index test) in symptomatic adult patients presenting to general practice, compared with multidisciplinary team-confirmed diagnosis of cancer (reference standard).
Diagnostic accuracy review following Cochrane methods was performed.
MEDLINE, EMBASE, Cochrane Library, the Database of Abstracts of Reviews of Effects and Medion databases.
Cross-sectional, cohort and randomised studies of test accuracy that compared gut feeling (index test) with an appropriate cancer diagnosis (reference standard). No language or publication status restrictions were applied. We included all studies published before 25 March 2022.
Methodological quality was appraised, using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria. Meta-analysis with hierarchical summary receiver operating characteristic (HSROC) models was used.
Of 1286 potentially relevant studies identified, six met the inclusion criteria. For two of the six studies, data could not be extracted despite contacting authors. No studies satisfied all QUADAS-2 criteria. After meta-analysis of data from the remaining studies, the summary point of HSROC had a sensitivity of 0.40 (95% CI: 0.28, 0.53) and a specificity of 0.85 (95% CI: 0.75, 0.92).
Gut feeling for cancer when used in symptomatic adult patients in general practice has a relatively low sensitivity and high specificity. When the prevalence of cancer in the symptomatic population presenting in general practice exceeds 1.15%, the performance of gut feeling reaches the National Institute for Health and Care Excellence 3% positive predictive value threshold for action, which recommends urgent access to specialist care and further investigations. The findings support the continued and expanded use of gut feeling items in referral pathways.
癌症的诊断延迟是初级保健中的一个挑战。虽然筛查测试在诊断某些癌症（如乳腺癌、结直肠癌和宫颈癌）方面非常有效，但由于其在初级保健中的发病率较低，以及患者焦虑、医患关系和社会心理背景的影响，基于症状的癌症诊断通常较为困难。在诊断资源有限的情况下，全科医生对癌症的直觉可能在早期诊断中发挥作用。本研究的目的是总结现有证据，了解在出现症状的成年患者就诊于全科医学时，直觉（指标测试）对癌症的诊断准确性，与多学科团队确诊的癌症（参考标准）进行比较。
根据 Cochrane 方法进行诊断准确性综述。
MEDLINE、EMBASE、Cochrane 图书馆、效应摘要数据库和 Medion 数据库。
比较直觉（指标测试）与适当癌症诊断（参考标准）的横断面、队列和随机研究。未对语言或出版状态进行限制。我们纳入了所有在 2022 年 3 月 25 日之前发表的研究。
使用 QUADAS-2 标准评估方法学质量。使用分层综合受试者工作特征（HSROC）模型进行荟萃分析。
在 1286 项潜在相关研究中，有 6 项符合纳入标准。尽管与作者联系，但有两项研究的数据无法提取。没有一项研究完全符合 QUADAS-2 标准。对其余研究的数据进行荟萃分析后，HSROC 的综合点的敏感度为 0.40（95%CI：0.28，0.53），特异度为 0.85（95%CI：0.75，0.92）。
当在出现症状的成年患者中使用时，癌症直觉的敏感度较低，特异性较高。当在出现症状的人群中出现癌症的患病率超过 1.15%时，直觉的表现达到了国家卫生与保健卓越研究所 3%的阳性预测值行动阈值，这建议紧急获得专家护理和进一步检查。这些发现支持继续和扩大使用直觉项目作为转诊途径。
