Table 5UPPER GASTROINTESTINAL CANCER: investigations

AuthorSettingDescriptionNo.InclusionExclusionResultsGold StdSetting
Allum et al , 2002UKThese joint guidelines of the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, the British Society of Gastroenterology, and the British Association of Surgical Oncology recommend that ‘Rapid access gastroscopy is the investigation of choice with appropriate biopsy for those with risk symptoms (grade C).’ They also state that ‘Antisecretory therapy should be ideally withheld until after endoscopy to avoid misdiagnosis (grade B).’The number of studies was not stated.----
Department of Health 2000The Department of Health guidelines did not consider primary care investigations for upper GI cancers other than referral for endoscopy.
Lionis, 2004Pancreatic cancer may present with jaundice. The jaundice is extra-hepatic and due to biliary obstruction. Hyperbilirubinaemia may be confirmed by testing the urine for bilirubin, and blood tests may then be arranged. A ratio of direct to indirect serum bilirubin of greater than 50% favours biliary obstruction. The sensitivity of ultrasound to detect biliary obstruction is 55–95%, while specificity is 82–95%.
NICE 2004Guidelines on the managements of dyspepsia in adultsStill out for consultation
Tatsuta 1989JapanPrimary study. The accuracy of gastrofibercopic biopsy in diagnosis of gastric malignancies was evaluated. Biopsy materials and cytologic specimens were examined in two independent laboratories by different doctors without knowledge of the endoscopic diagnosis1331 patientsGastrofiberscopic biopsy was performed during follow-up of all 1331 patients examined from 1968–1976Those without benign lesions were not followed up.There were 31 (3.7%) false-negative diagnoses of malignancy among 858 patients diagnosed as having benign lesions and 3 (0.6%) false-positive diagnoses among 473 patients diagnosed as having malignant tumours.Histology

From: Appendix A, Evidence Tables

Cover of Referral Guidelines for Suspected Cancer in Adults and Children
Referral Guidelines for Suspected Cancer in Adults and Children [Internet].
NICE Clinical Guidelines, No. 27.
Clinical Governance Research and Development Unit (CGRDU), Department of Health Sciences, University of Leicester.
Copyright © 2005, National Collaborating Centre for Primary Care.

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