Ramachandran Krishnappriya, Thankagunam Balamugesh, Karuppusami Reka, Christopher D J
Assistant Professor, Department of Respiratory Medicine, Meenakshi Medical College Hospital and Research Institute , Enathur, Kanchipuram, Tamil Nadu, India .
Professor, Department of Pulmonary Medicine, Christian Medical College and Hospital , Vellore, Tamil Nadu, India .
J Clin Diagn Res. 2016 Nov;10(11):OC05-OC08. doi: 10.7860/JCDR/2016/22737.8823. Epub 2016 Nov 1.
Lung cancer is associated with a poor prognosis, if detected late in the disease course. Delay in seeking health care, wrong diagnosis and delay in specialist referral can contribute to delay in diagnosis.
This study was done to assess physician related delays in the diagnosis of lung cancer and the treatments given before presenting to our center.
A total of 96 consecutive patients diagnosed with lung cancer were enrolled in this study. Details of previous physician consultations, their specialization, diagnoses made and treatments given were obtained from records available with the patients.
Patients, on an average consulted two physicians before presenting to our center. Less than half of the physicians (45%) suspected lung cancer during their evaluation. Around 18% of physicians made an incorrect diagnosis of tuberculosis, out of whom, 88.6% had prescribed anti-tuberculous therapy. Only 27% of physicians referred the patients to higher medical centres for evaluation. Pulmonology Specialists (PS) were the most likely to diagnose lung cancer (p<0.0001). General Medicine Specialists (GMS) were the most likely to misdiagnose cancer as tuberculosis, followed by General Practioners (GP) when compared to PS (p-value =0.0422).
Our study demonstrates that, many physicians have a low index of suspicion to diagnose lung malignancy and most commonly misdiagnose it as tuberculosis. It is likely that most patients failed to seek the services of PS directly or through referral either due to a shortage of PS or due to other reasons.
如果在疾病进程的晚期才被发现，肺癌的预后较差。寻求医疗护理的延迟、错误诊断以及专科转诊的延迟都可能导致诊断延迟。
本研究旨在评估医生在肺癌诊断方面的相关延迟以及在前来本中心就诊之前所给予的治疗。
本研究共纳入96例连续诊断为肺癌的患者。从患者提供的记录中获取先前医生咨询的详细信息、他们的专业、做出的诊断以及给予的治疗。
患者在前来本中心就诊之前平均咨询了两位医生。不到一半的医生（45%）在评估过程中怀疑是肺癌。约18%的医生对结核病做出了错误诊断，其中88.6%的医生开具了抗结核治疗药物。只有27%的医生将患者转诊至上级医疗中心进行评估。肺科专家（PS）最有可能诊断出肺癌（p<0.0001）。与PS相比，普通内科专家（GMS）最容易将癌症误诊为结核病，其次是全科医生（GP）（p值=0.0422）。
我们的研究表明，许多医生对诊断肺恶性肿瘤的怀疑指数较低，最常见的是将其误诊为结核病。很可能大多数患者由于PS短缺或其他原因未能直接或通过转诊寻求PS的服务。
