Real-world validation of the cancer dysphagia score for primary care triage of suspected upper gastrointestinal cancer referrals.

INTRODUCTION

The National Institute for Health and Care Excellence guideline NG12 recommends urgent suspected cancer referrals for adults presenting with dysphagia. Diagnostic yield from upper gastrointestinal endoscopy in this cohort is around 1%. The Cancer Dysphagia Score (CDS) offers a simplified risk stratification tool with a reported sensitivity of 97.8% and negative predictive value (NPV) of 99.5% for upper GI malignancy. This study externally validates the real-world safety and performance of a modified CDS calculated by general practitioners (GPs) to triage dysphagia referrals.

METHODS

A retrospective external validation study was conducted across a single NHS trust including adults referred on the suspected cancer pathway for dysphagia between April 2024 and April 2025. A modified CDS compatible with the PRISM electronic referral system was applied by GPs. Data were extracted from the Somerset Cancer Database. Patients were stratified as high (CDS ≥5.5) or low (<5.5) risk. Diagnostic outcomes were confirmed endoscopically and histopathologically. Sensitivity, specificity, positive predictive value (PPV), NPV and relative risk (RR) were calculated.

RESULTS

Of 2,447 referrals, 2,425 met inclusion criteria (1,670 high risk; 755 low risk) and 78 cancers were diagnosed (3.2% detection rate). Cancer prevalence was 4.6% in the high-risk group and 0.3% in the low-risk group. The adjusted CDS achieved sensitivity 97.4%, specificity 32.1%, PPV 4.6%, NPV 99.7% and RR 17.2 (95% CI 4.2-69.8).

CONCLUSIONS

GP-applied CDS maintained high sensitivity and NPV, safely identifying low-risk dysphagia patients suitable for routine referral. Incorporating the CDS into suspected cancer referral pathway could optimise endoscopy resource allocation without compromising cancer detection.