Clinical–alimentary tractLimited Value of Alarm Features in the Diagnosis of Upper Gastrointestinal Malignancy: Systematic Review and Meta-analysis
Section snippets
Searches
Two authors (N.V., P.M.) performed independent electronic database searches of MEDLINE (1966-December 2003), EMBASE (1988- January 2005), Cochrane Controlled Trials Register (January 2005), and CINAHL (1982-January 2005). Papers on upper gastrointestinal neoplasia were identified with the following terms: stomach neoplasms, esophageal neoplasms (all mesh heading and free text terms), gastric adj5 cancer, gastric adj5 adenocarcinoma, (o)esophageal adj5 adenocarcinoma, (o)esophageal adj5 cancer,
Results
After the initial screening of 2635 papers detected by the general search strategy, we identified 85 citations on alarm features that were evaluated in more detail (Figure 1). Of these, 15 studies met the inclusion criteria for a prospective evaluation of alarm features8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22 with excellent agreement between reviewers (κ = .90; 95% confidence intervals [CI]: .76–.96). A total of 57,363 dyspeptic patients were evaluated in the eligible papers, of
Discussion
The results of this analysis suggest that alarm features, clinical diagnoses, and computer models are relatively inaccurate predictors of an underlying malignancy. When present, alarm features have low positive predictive values for an underlying upper GI malignancy. The likelihood is that an upper GI malignancy increases slightly if an alarm feature is present, but the absolute increase in detected cases was small. The negative predictive value was high for all individual alarm features and
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