Development and validation of a multivariable risk factor questionnaire to detect oesophageal cancer in 2-week wait patients.

INTRODUCTION: Oesophageal cancer is associated with poor health outcomes. Upper GI (UGI) endoscopy is the gold standard for diagnosis but is associated with patient discomfort and low yield for cancer. We used a machine learning approach to create a model which predicted oesophageal cancer based on questionnaire responses. METHODS: We used data from 2 separate prospective cross-sectional studies: the Saliva to Predict rIsk of disease using Transcriptomics and epigenetics (SPIT) study and predicting RIsk of diSease using detailed Questionnaires (RISQ) study. We recruited patients from National Health Service (NHS) suspected cancer pathways as well as patients with known cancer. We identified patient characteristics and questionnaire responses which were most associated with the development of oesophageal cancer. Using the SPIT dataset, we trained seven different machine learning models, selecting the best area under the receiver operator curve (AUC) to create our final model. We further applied a cost function to maximise cancer detection. We then independently validated the model using the RISQ dataset. RESULTS: 807 patients were included in model training and testing, split in a 70:30 ratio. 294 patients were included in model validation. The best model during training was regularised logistic regression using 17 features (median AUC: 0.81, interquartile range (IQR): 0.69-0.85). For testing and validation datasets, the model achieved an AUC of 0.71 (95% CI: 0.61-0.81) and 0.92 (95% CI: 0.88-0.96) respectively. At a set cut off, our model achieved a sensitivity of 97.6% and specificity of 59.1%. We additionally piloted the model in 12 patients with gastric cancer; 9/12 (75%) of patients were correctly classified. CONCLUSIONS: We have developed and validated a risk stratification tool using a questionnaire approach. This could aid prioritising patients at high risk of having oesophageal cancer for endoscopy. Our tool could help address endoscopic backlogs caused by the COVID-19 pandemic.

Cytosponge as a risk stratification tool in patients overdue barrett’s surveillance due to Covid-19

HFR-1 Table 1Demographics, baseline Barrett’s baseline information and outcome of all patients who have completed the Cytosponge ® procedure. * 2 patients still awaiting endoscopic assessment. NDBE: Non-Dysplastic Barrett’s Oesophagus, INDEF: Indefinite for dysplasia, LGD: Low-Grade Dysplasia, IMC: intramucosal adenocarcinoma TFF3: - Atypia: - P53: - TFF3: + Atypia: - P53: - TFF3: -/+ Atypia: + P53: - TFF3: + Atypia: + P53: + Number of patients 14 26 12 4 M:F 12 : 2 20 : 6 11 : 1 4 : 0 Median maximal BE length (cm) 2.5 5 5 6 Triage decision Repeat Cytosponge®/endoscopy within 24 months Endoscopy in 12 months Endoscopy within 3 months Endoscopy within 3 months Endoscopy and histology findings - - NDBE: 5 ATYPIA: 1 INDEF: 2 LGD: 2 NDBE: 1 LGD: 2 IMC: 1 ConclusionsThe Cytosponge® has proved to be an acceptable non-endoscopic tool for patients with BE under surveillance where endoscopy is not possible. Preliminary data are promising to detect dysplasia and triage patients to endoscopy early. Further large scale, longitudinal follow-up is needed.