Development and External Validation of an Improved Version of the Diagnostic Model for Opportunistic Screening of Malignant Esophageal Lesions

SIMPLE SUMMARY: Simple and effective risk stratification tools which allow prediction of the risk of malignant esophageal lesions are needed for the practice of opportunistic screening. The aim of the current study was to develop an improved version of the diagnostic model based on a large-scale outpatient cohort and assess the robustness and generalizability of the model through external validations. The improved diagnostic model had seven predictors and generated an area under the receiver operating characteristic curve of 0.860 in the development set. Validation of the model in two external populations also showed high discrimination power and was able to increase the detection rate of malignant esophageal lesions. This questionnaire-based diagnostic model provides an easy-to-use tool to identify high-risk individuals and will be useful for the promotion of the opportunistic screening of esophageal cancer. ABSTRACT: We aimed to develop an improved version of the diagnostic model predicting the risk of malignant esophageal lesions in opportunistic screening and validate it in external populations. The development set involved 10,595 outpatients receiving endoscopy from a hospital in Hua County, a high-risk region for esophageal squamous cell carcinoma in northern China. Validation set A enrolled 9453 outpatients receiving endoscopy in a non-high-risk region in southern China. Validation set B involved 17,511 residents in Hua County. The improved diagnostic model consisted of seven predictors including age, gender, family history of esophageal squamous cell carcinoma, smoking, body mass index, dysphagia, and retrosternal pain, with an area under the receiver operating characteristic curve (AUC) of 0.860 (95% confidence interval: 0.835–0.886) in the development set. Ideal discrimination ability was achieved in external validations (AUC (validation set A): 0.892, 95% confidence interval: 0.858–0.926; AUC (validation set B): 0.799, 95% confidence interval: 0.705–0.894). This improved model also markedly increased the detection rate of malignant esophageal lesions compared with universal screening, demonstrating great potential for use in opportunistic screening of malignant esophageal lesions in heterogeneous populations.