Post written by Yang Ke, MD, and Zhonghu He, PhD, from the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China.

Endoscopic screening provides an opportunity for early detection and endoscopic therapy of esophageal lesions. In contrast to organized screening programs, which require central management and monitoring, opportunistic screening, which refers to detection of lesions in people who present to healthcare professionals for various complaints, should be the main screening modality in clinical settings, especially for regions without an organized screening program. Two crucial preconditions of opportunistic screening are: a) high-grade evidence proving the effectiveness of the screening, b) an appropriate risk stratification tool for use in distinguishing high-risk individuals from outpatients in general. The aim of this study was to develop a prediction model for estimating the risk of high-grade esophageal lesions for application in opportunistic screening settings.

China has a high incidence of esophageal cancer. A useful risk-stratification tool will greatly support personalized referral for endoscopic examination in opportunistic screening. However, no such tool has been developed and validated for application in opportunistic screening for esophageal cancer, which has been one of the principal barriers to establishing opportunistic screening strategy for esophageal cancer in China.

We constructed a clinical risk prediction model based on results of endoscopic evaluation of outpatient cohorts from southern and northern China. This model with 5 easily acquired predictors demonstrated high discrimination accuracy in both development (AUC: 0.871) and external validation populations (AUC: 0.843). The model successfully stratified the clinical population into 3 risk groups and showed high ability for concentrating cases.

This model has the potential for application in clinical opportunistic screening to aid decision-making for both healthcare professionals and individual outpatients. The estimated risk may help distinguish individuals with different levels of risk and allow for tailoring advice regarding further endoscopy examination.

Receiver operating characteristic curves of the prediction model for severe dysplasia and above in the development set (A) and the validation set (B). AUC, Area under the curve.

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