Table 4.
Sensitivities, specificities, positive predictive values, negative predictive values, positive likelihood ratios, negative likelihood ratios, areas under the receiver operating characteristic, and 95% confidence intervals of Barrett’s esophagus screening guidelines for five gastrointestinal societies in an unscreened primary care population.
| Guidelines | Sensitivity (95% CI) | Specificity (95% CI) | PPV (95% CI) | NPV (95% CI) | +LR (95% CI) | −LR (95% CI) | AUROC (95% CI) |
|---|---|---|---|---|---|---|---|
| American College of Gastroenterology | |||||||
| Men with GERD and ≥ 2 risk factorsǂ | 38.6% (24.4%–54.5%) | 76.5% (72.5%–80.3%) | 13.4% (8.0%–20.6%) | 93.0% (90.0%–95.3%) | 1.65 (1.10–2.47) | 0.80 (0.63–1.02) | 0.58 (0.50–0.65) |
| American Gastroenterological Association | |||||||
| Multiple risk factors | |||||||
| ≥2 of any risk factorsΣ | 100.0% (92.0%–100.0%) | 0.2% (0.0%–1.2%) | 8.6% (6.3%–11.4%) | 100.0% (2.5%–100.0%) | 1.00 (1.00–1.01) | 0.00 (--) | 0.50 (0.50–0.50) |
| ≥50 years and male | 97.7% (88.0%–99.9%) | 5.8% (3.8%–8.3%) | 8.9% (6.5%–11.8%) | 96.4% (81.7%–99.9%) | 1.04 (0.99–1.09) | 0.39 (0.05–2.84) | 0.52 (0.49–0.54) |
| Male and overweight/obesity or high WHR | 97.7% (88.0%–99.9%) | 9.2% (6.7%–12.2%) | 9.2% (6.7%–12.2%) | 97.7% (88.0%–99.9%) | 1.08 (1.02–1.13) | 0.25 (0.03–1.76) | 0.53 (0.51–0.56) |
| ≥50 years and overweight/obese or high WHR | 95.5% (84.5%–99.4%) | 8.3% (6.0%–11.2%) | 8.9% (6.5%–11.8%) | 95.1% (83.5%–99.4%) | 1.04 (0.97–1.12) | 0.55 (0.14–2.19) | 0.52 (0.49–0.55) |
| Male and non-Hispanic white | 68.2% (52.4%–81.4%) | 55.0% (50.4%–59.6%) | 12.5% (8.6%–17.3%) | 94.9% (91.5%–97.2%) | 1.52 (1.21–1.90) | 0.58 (0.37–0.90) | 0.62 (0.54–0.69) |
| ≥50 years and non-Hispanic white | 68.2% (52.4%–81.4%) | 54.6% (50.0%–59.2%) | 12.3% (8.5%–17.2%) | 94.8% (91.5%–97.1%) | 1.50 (1.20–1.88) | 0.58 (0.38–0.91) | 0.61 (0.54–0.69) |
| Non-Hispanic white and overweight/obese or high WHR | 65.9% (50.1%–79.5%) | 55.7% (51.0%–60.2%) | 12.2% (8.4%–17.1%) | 94.6% (91.2%–96.9%) | 1.49 (1.17–1.88) | 0.61 (0.40–0.93) | 0.61 (0.53–0.68) |
| Male and chronic GERD | 40.9% (26.3%–56.8%) | 76.5% (72.4%–80.3%) | 14.1% (8.6%–21.3%) | 93.2% (90.3%–95.5%) | 1.74 (1.18–2.58) | 0.77 (0.60–0.99) | 0.59 (0.51–0.66) |
| ≥50 years and chronic GERD | 40.9% (26.3%–56.8%) | 75.5% (71.3%–79.3%) | 13.5% (8.2%–20.5%) | 93.2% (90.1%–95.5%) | 1.67 (1.13–2.46) | 0.78 (0.61–1.01) | 0.58 (0.51–0.66) |
| Overweight/obese or high WHR and chronic GERD | 38.6% (24.4%–54.5%) | 75.5% (71.3%–79.3%) | 12.9% (7.7%–19.8%) | 92.9% (89.9%–95.3%) | 1.58 (1.05–2.36) | 0.81 (0.64–1.03) | 0.57 (0.50–0.65) |
| Non-Hispanic white and chronic GERD | 27.3% (15.0%–42.8%) | 86.8% (83.4%–89.7%) | 16.2% (8.7%–26.6%) | 92.7% (89.9%–95.0%) | 2.06 (1.21–3.52) | 0.84 (0.70–1.01) | 0.57 (0.50–0.64) |
| ≥3 risk factorsΣ | 88.6% (75.4%–96.2%) | 5.5% (3.7%–8.0%) | 8.1% (5.8%–10.9%) | 83.9% (66.3%–94.5%) | 0.94 (0.84–1.05) | 2.05 (0.83–5.07) | 0.47 (0.42–0.52) |
| ≥4 risk factorsΣ | 72.7% (57.2%–85.0%) | 46.3% (41.7%–50.9%) | 11.3% (7.8%–15.5%) | 94.8% (91.0%–97.3%) | 1.35 (1.11–1.65) | 0.59 (0.36–0.96) | 0.59 (0.52–0.67) |
| ≥5 risk factorsΣ | 20.5% (9.8%–35.3%) | 87.8% (84.5%–90.7%) | 13.6% (6.4%–24.3%) | 92.2% (89.3%–94.5%) | 1.68 (0.90–3.16) | 0.91 (0.78–1.06) | 0.54 (0.48–0.60) |
| American Society for Gastrointestinal Endoscopy | |||||||
| Family hx of BE/EAC or GERD and ≥ 1 risk factor± | 43.2% (28.3%–59.0%) | 71.6% (67.3%–75.7%) | 12.5% (7.7%–18.8%) | 93.1% (89.9%–95.5%) | 1.52 (1.05–2.20) | 0.79 (0.61–1.03) | 0.57 (0.50–0.65) |
| British Society of Gastroenterology | |||||||
| GERD and ≥ 3 risk factors** | 40.9% (26.3%–56.8%) | 75.7% (71.5%–79.5%) | 13.6% (8.3%–20.7%) | 93.2% (90.2%–95.5%) | 1.68 (1.14–2.48) | 0.78 (0.61–1.00) | 0.58 (0.51–0.66) |
| European Society of Gastrointestinal Endoscopy | |||||||
| GERD>5 years and multiple risk factors | |||||||
| ≥2 risk factors* | 40.9% (26.3%–56.8%) | 75.1% (70.9%–78.9%) | 13.3% (8.1%–20.3%) | 93.1% (90.1%–95.5%) | 1.64 (1.11–2.42) | 0.79 (0.61–1.01) | 0.58 (0.50–0.66) |
| ≥3 risk factors* | 36.4% (22.4%–52.2%) | 82.9% (79.2%–86.2%) | 16.7% (9.8%–25.6%) | 93.3% (90.4%–95.5%) | 2.13 (1.37–3.31) | 0.77 (0.61–0.96) | 0.60 (0.52–0.67) |
| ≥4 risk factors* | 13.6% (5.2%–27.4%) | 92.1% (89.3%–94.4%) | 14.0% (5.3%–27.9%) | 91.9% (89.1%–94.2%) | 1.73 (0.77–3.87) | 0.94 (0.83–1.06) | 0.53 (0.48–0.58) |
age ≥50 years, male sex, non-Hispanic white race, obesity, or first degree relative with BE or EAC.
age ≥50 years, male sex, non-Hispanic white race, or obesity or high WHR. Lower threshold in family history of BE or EAC.
age >50 years, male sex, current or previous smoking, or obesity or high WHR.
age >50 years, non-Hispanic white race, high WHR, current or previous smoking, or family history of BE or EAC.
age ≥50 years, male sex, non-Hispanic white race, chronic GERD, or elevated BMI (defined here as overweight or obese) or intra-abodminal distribution of body fat (defined here as high WHR).
Abbreviations: CI, confidence interval; PPV, positive predictive value; NPV, negative predictive value; +LR, positive likelihood ratio; −LR, negative likelihood ratio; AUROC, area under the receiver operating characteristic.