{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T19:49:33Z","timestamp":1792093773988,"version":"4.4.0"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2016,1,7]],"date-time":"2016-01-07T00:00:00Z","timestamp":1452124800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2016,2]]},"abstract":"Objectives<\/jats:title>To identify the set of referral criteria that will offer optimal diagnostic efficacy in patients suspected to have head and neck cancer (HNC<\/jats:styled-content>) in the primary care setting.<\/jats:p><\/jats:sec>Design<\/jats:title>Statistical analysis of referral criteria and outcomes.<\/jats:p><\/jats:sec>Setting<\/jats:title>Two tertiary care cancer centres in the United Kingdom.<\/jats:p><\/jats:sec>Participants<\/jats:title>4715 patients who were referred via the fast\u2010track system with a suspected HNC<\/jats:styled-content> between 2007 and 2010.<\/jats:p><\/jats:sec>Main outcome measures<\/jats:title>Parameters of diagnostic efficacy, multivariate regression model to calculate estimated probability of HNC<\/jats:styled-content> and area under the receiver operating characteristic curve (AUROC<\/jats:styled-content>).<\/jats:p><\/jats:sec>Results<\/jats:title>The majority of referring symptoms had a positive predictive value higher than the 3% cut\u2010off point stated to be significant for HNC<\/jats:styled-content> detection in the 2015 NICE<\/jats:styled-content> recommendations. Nevertheless, our multivariate analysis identified nine symptoms to be linked with HNC<\/jats:styled-content>. Of these, only four are included in the latest NICE<\/jats:styled-content> guidelines. The best fit predictive model for this data set included the following symptoms: hoarseness >3\u00a0weeks, dysphagia >3\u00a0weeks, odynophagia, unexplained neck mass, oral swelling >3\u00a0weeks, oral ulcer >3\u00a0weeks, prolonged otalgia with normal otoscopy, the presence of blood in mouth with concurrent sensation of lump in throat and the presence of otalgia with concurrent lump in throat sensation. Intermittent hoarseness and sensation of lump in throat were negatively associated with HNC<\/jats:styled-content>. The AUROC<\/jats:styled-content> demonstrated that our model had a higher predictive value (0.77) compared to those generated using the NICE<\/jats:styled-content> 2005 (0.69) and 2015 (0.68) referral criteria (P<\/jats:italic>\u00a0<\u00a00.0001). An online risk calculator based on this study is available at http:\/\/www.orlhealth.com\/risk-calculator.html<\/jats:ext-link>.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>This study presents a significantly refined version of referral guidelines which demonstrate greater diagnostic efficacy than the current NICE<\/jats:styled-content> guidelines. We recommend that further iterative refinements of referral criteria be considered when referring patients with suspected HNC<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.12597","type":"journal-article","created":{"date-parts":[[2015,11,27]],"date-time":"2015-11-27T08:19:39Z","timestamp":1448612379000},"page":"66-75","source":"Crossref","is-referenced-by-count":32,"title":["Refining the head and neck cancer referral guidelines: a two\u2010centre analysis of 4715 referrals"],"prefix":"10.1111","volume":"41","author":[{"given":"T.","family":"Tikka","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Head\u2010Neck Surgery Queen Elizabeth Hospital University Hospitals Birmingham NHS Foundation Trust Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Pracy","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head\u2010Neck Surgery Queen Elizabeth Hospital University Hospitals Birmingham NHS Foundation Trust Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Paleri","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head\u2010Neck Surgery Freeman Hospital Newcastle upon Tyne University Hospitals NHS Trust Newcastle upon Tyne UK"},{"name":"Northern Institute for Cancer Research Newcastle University Newcastle upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,1,7]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"National Head and Neck Cancer Audit, Open Data \u2013 2012","author":"Health & Social Care Information Centre","year":"2012"},{"key":"e_1_2_11_3_1","volume-title":"Profile of Head and Neck Cancer in England: Incidence, Mortality and Survival","author":"Oxford Cancer Intelligence Unit","year":"2010"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.125.2.142"},{"key":"e_1_2_11_5_1","volume-title":"Improving Outcomes in Head and Neck Cancers: The Manual","author":"National Institute of Clinical Excellence","year":"2015"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1308\/147363502761019582"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0307-7772.2004.00744.x"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2005.02.013"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215108002004"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bdj.4814304"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2753.2006.00607.x"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2007.10.010"},{"key":"e_1_2_11_13_1","volume-title":"Referral Guidelines for Suspected Cancer","author":"National Institute for Health and Care Excellence","year":"2005"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2013.06.246"},{"key":"e_1_2_11_15_1","first-page":"102","article-title":"Efficacy of the Two Week Wait referral system for Head and Neck Cancer: A Systematic Review","volume":"94","author":"Kumar R.","year":"2012","journal-title":"Ann. 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