Evidence map›Paper›PMID 32274084›Full record

ArticleJournal of thoracic disease2020

Development of a clinical score to distinguish malignant from benign esophageal disease in an undiagnosed patient population referred to an esophageal diagnostic assessment program.

Negar Ahmadi, Lawrence Mbuagbaw, Waël C Hanna, Christian Finley, John Agzarian, Chuck K Wen, Michal Coret, Colin Schieman, Yaron Shargall

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of thoracic disease, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
0.2field-weighted citation impact, top 49% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it, 3 citations in OpenAlex.

  1. Diagnostic Risk Prediction Models for Upper Gastrointestinal Cancers: A Systematic Review.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2025
    Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 1 country.

Negar AhmadiDivision of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
Lawrence MbuagbawDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Waël C HannaDivision of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
Christian FinleyDivision of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
John AgzarianDivision of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
Chuck K WenDivision of Thoracic Surgery, University of British Columbia, Surrey, BC, Canada.
Michal CoretDivision of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
Colin SchiemanSection of Thoracic Surgery, University of Calgary, Calgary, AB, Canada.
Yaron ShargallDivision of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
St. Joseph’s Healthcare Hamilton · CAMcMaster University · CAUniversity of British Columbia · CAUniversity of Calgary · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEsophageal cancer is associated with poor prognosis. Diagnosis is often delayed, resulting in presentation with advanced disease. We developed a clinical score to predict the risk of a malignant diagnosis in symptomatic patients prior to any diagnostic tests.

methodsWe analyzed data from patients referred to a regional esophageal diagnostic assessment program between May 2013 and August 2016. Logistic regression was performed to identify predictors of malignancy based on patient characteristics and symptoms. Predicted probabilities were used to develop a score from 0 to 10 which was weighted according to beta coefficients for predictors in the model. Score accuracy was evaluated using a receiver operating characteristic (ROC) curve and internally validated using bootstrapping techniques. Patients were classified into low (0-2 points), medium (3-6 points), and high (7-10 points) risk groups based on their scores. Pathologic tissue diagnosis was used to assess the effectiveness of the developed score in predicting the risk of malignancy in each group.

resultsOf 530 patients, 363 (68%) were diagnosed with malignancy. Factors predictive of malignancy included male sex, family history of cancer and esophageal cancer, fatigue, chest/throat/back pain, melena and weight loss. These factors were allocated 1-2 points each for a total of 10 points. Low-risk patients had 70% lower chance of malignancy (RR =0.28, 95% CI: 0.21-0.38), medium-risk had 50% higher chance of malignancy (RR =1.5, 95% CI: 1.26-1.77), and high-risk patients were 8 times more likely to be diagnosed with malignancy (RR =8.2, 95% CI: 2.60-25.86). The area under the ROC curve for malignancy was 0.82 (95% CI: 0.77-0.87).

conclusionsA simple score using patient characteristics and symptoms reliably distinguished malignant from benign diagnoses in a population of patients with upper gastrointestinal symptoms. This score might be useful in expediting investigations, referrals and eventual diagnosis of malignancy.

Indexed as

diagnostic assessment programdysphagiaEsophageal canceresophageal cancer screening

Identifiers

PMID32274084
PMCPMC7139012
OpenAlexW3008284315

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.