颈部淋巴结和不明原发灶鳞状细胞癌患者的治疗延误：一项回顾性队列研究。
Management delays in patients with squamous cell cancer of neck node(s) and unknown primary site: a retrospective cohort study.
机构信息
Division of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.
Department of Oncology, University of Calgary, 1331 29 Street Northwest, Calgary, AB, T2N 4 N2, Canada.
出版信息
J Otolaryngol Head Neck Surg. 2017 May 8;46(1):39. doi: 10.1186/s40463-017-0217-z.
BACKGROUND
We aim to characterize the workup received by and identify any delays to diagnosis or treatment in patients referred to a tertiary cancer centre with the diagnosis of squamous cell carcinoma in neck node(s) and no identifiable primary (SCCNIP).
METHODS
Over 1 year, 68 patients were initially referred to the Head and Neck clinic with a label of "primary unknown". After extensive workup, 29 of the 68 patients were found to have pathologically confirmed SCCNIP. For these 29 patients, imaging tests, biopsies, examinations and times to treatment were reviewed and compared to 145 patients referred for known primaries.
RESULTS
In 21/29 (72%) patients, ultrasound was ordered prior to biopsy or referral. After referral, the first imaging test used was CT neck in 28 patients and PET/CT in 1 patient. Median time from referral to primary identification (n = 23) or workup completion (n = 6) were 16 (range: 0-48) and 36 (17-82) days respectively. Median time from referral to treatment was 55 (27-90; n = 26) days and was longer than those referred for known primaries (48 days; 20-162; p < 0.001). Across all patients, median time between first diagnostic imaging test and pathologic diagnosis were 20.5 and -8.0 days (p < 0.0001) in patients receiving ultrasound and CT, respectively.
CONCLUSIONS
In our cohort, delays to management were linked to community use of ultrasound and scheduling of both CT and PET/CT after thorough head and neck examination in patients with SCCNIP.
背景
我们旨在描述在被转诊至三级癌症中心的患者中，那些诊断为颈部淋巴结鳞状细胞癌且无法识别原发性肿瘤（SCCNIP）患者的检查和治疗延迟情况。
方法
在超过 1 年的时间里，共有 68 名患者最初被转诊至头颈部诊所，诊断为“原发性不明”。经过广泛的检查，在这 68 名患者中，有 29 名患者被病理证实为 SCCNIP。对这 29 名患者的影像学检查、活检、检查和治疗时间进行了回顾，并与 145 名被转诊为已知原发性肿瘤的患者进行了比较。
结果
在 29 名患者中，有 21 名（72%）患者在活检或转诊前进行了超声检查。转诊后，28 名患者首先进行了颈部 CT 检查，1 名患者进行了 PET/CT 检查。从转诊到确定原发性肿瘤（n=23）或完成检查（n=6）的中位时间分别为 16 天（范围：0-48 天）和 36 天（17-82 天）。从转诊到治疗的中位时间为 55 天（27-90 天；n=26），长于已知原发性肿瘤患者（48 天；20-162 天；p<0.001）。在所有患者中，在接受超声和 CT 的患者中，第一次诊断性影像学检查与病理诊断之间的中位时间分别为 20.5 天和-8.0 天（p<0.0001）。
结论
在我们的队列中，管理延迟与社区使用超声以及在 SCCNIP 患者彻底进行头颈部检查后安排 CT 和 PET/CT 有关。
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