Abstract
BackgroundIn patients presenting with peripheral lymphadenopathy, it is critical to effectively identify those with underlying cancer who require urgent specialist care.MethodsWe analyzed a large dataset of 1000 consecutive patients with unexplained lymphadenopathy referred between 2001 and 2009 to the Royal Marsden Hospital (RMH) rapid access lymph node diagnostic clinic (LNDC).ResultsCancer was diagnosed in 14% of patients. Factors predictive for malignant disease were male sex, age, supraclavicular and multiple site involvement. Cancer-associated symptoms were present for a median of 8 weeks. The median time from referral to start of cancer therapy was 53 days. Fine needle aspiration (FNA) was performed in 83% of patients with malignancies. Sensitivity and specificity of FNA were limited (50 and 87%, respectively for any malignancy; 30 and 79%, respectively for lymphoma). The vast majority of cancer patients received diagnostic biopsies on the basis of suspicious clinical and ultrasound findings; the FNA result contributed to establishing the diagnosis in only 4 cases.ConclusionsIn conclusion, we demonstrate that Oncologist-led rapid access clinics are successful concepts to assess patients with unexplained lymphadenopathy. Our data suggest that a routine use of FNA should be reconsidered in this setting.
Highlights
In patients presenting with peripheral lymphadenopathy, it is critical to effectively identify those with underlying cancer who require urgent specialist care
Lymphomas comprise a heterogeneous group of hematologic malignancies, the most common ones being diffuse large B cell lymphoma (DLBCL), follicular lymphoma (FL) and Hodgkin lymphoma (HL)
The lymph node diagnostic clinic (LNDC) at Royal Marsden Hospital (RMH) was established in 1996 as a rapid access clinic for patients with unexplained lymphadenopathy referred by their General Practitioners [5]
Summary
In patients presenting with peripheral lymphadenopathy, it is critical to effectively identify those with underlying cancer who require urgent specialist care. When assessing patients with unexplained lymphadenopathy, the main challenge is to identify patients with malignancy or other critical conditions requiring urgent specialist care. Lymphomas are among the most common malignant diagnoses in patients with unclear lymphadenopathy, with the incidence anticipated to rise in the decades. Lymphomas comprise a heterogeneous group of hematologic malignancies, the most common ones being diffuse large B cell lymphoma (DLBCL), follicular lymphoma (FL) and Hodgkin lymphoma (HL). Lymphoma patients often present with unspecific symptoms commonly seen in non-severe illnesses, which can cause significant delays to specialist referral [4]. Excision biopsy remains the gold standard for diagnosing lymphoma and the full histological work-up requires complex immunohistochemical analyses by an experienced histopathologist. Diagnosis and start of treatment is considered important for DLBCL and HL patients who can be cured by multi-agent chemotherapies
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