Pannick S A J, Ingham Clark C L
Department of Surgery, Whittington Hospital, London, UK.
Ann R Coll Surg Engl. 2009 Nov;91(8):673-6. doi: 10.1308/003588409X12486167521118. Epub 2009 Sep 25.
Patients with lymphadenopathy are commonly referred to general surgeons for diagnostic lymph node biopsy. We were concerned at potential long waits for this service in our hospital and thus wanted to compare the efficiency of written and telephone referral with a view to identifying the optimum care pathway for these patients.
Sixty patients were included in a 2-year retrospective review (excluding referrals associated with breast lumps which were managed separately). Hospital Episode Statistics data were used to analyse notes for the source and method of referral, waiting time to biopsy, clinic attendance and diagnosis.
Of referrals, 33% were from haematology and 28% from general practice. Overall, 47% of patients were referred by letter; of these, 64% were seen in clinic before biopsy. Personal referral between clinicians, by direct discussion, e-mail or fax led to a mean wait of 4 days, compared to 51 days when patients were referred by letter. Clinic attendance had no significant bearing on diagnostic accuracy or complication rate. Neoplasia accounted for 43% of diagnoses and infection (including four cases of tuberculosis) for 10%. Of biopsies, 33% showed benign changes, 8% were unrecorded and 5% were incorrect.
In this study, 43% of biopsies revealed malignancy and we advise that lymph node biopsy requests should be managed on a fast-track pathway, expedited by direct personal request. Following this study, we have implemented a fast-track pathway for such patients.
患有淋巴结病的患者通常会被转诊至普通外科医生处进行诊断性淋巴结活检。我们担心我院该项服务可能存在较长的等待时间，因此希望比较书面转诊和电话转诊的效率，以便为这些患者确定最佳的护理途径。
对60例患者进行了为期2年的回顾性研究（不包括与乳腺肿块相关的转诊，此类转诊另行处理）。利用医院病历统计数据来分析转诊来源和方式、活检等待时间、门诊就诊情况及诊断结果的记录。
转诊患者中，33%来自血液科，28%来自全科医疗。总体而言，47%的患者通过信件转诊；其中，64%在活检前到门诊就诊。临床医生之间通过直接讨论、电子邮件或传真进行的个人转诊导致的平均等待时间为4天，而通过信件转诊的患者平均等待时间为51天。门诊就诊对诊断准确性或并发症发生率没有显著影响。肿瘤占诊断结果的43%，感染（包括4例结核病）占10%。活检结果中，33%显示良性改变，8%未记录，5%有误。
在本研究中，43%的活检显示为恶性，我们建议淋巴结活检申请应通过直接个人申请的快速通道进行处理。基于本研究，我们已为这类患者实施了快速通道。
