Kühnl Andrea, Cunningham David, Hutka Margaret, Peckitt Clare, Rozati Hamoun, Morano Federica, Chong Irene, Gillbanks Angela, Wotherspoon Andrew, Harris Michelle, Murray Tracey, Chau Ian
1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK.
2Department of Computing, Royal Marsden NHS Foundation Trust, London, Surrey UK.
BMC Hematol. 2018 Aug 14;18:19. doi: 10.1186/s12878-018-0109-0. eCollection 2018.
In patients presenting with peripheral lymphadenopathy, it is critical to effectively identify those with underlying cancer who require urgent specialist care.
We 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).
Cancer 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.
In 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.
对于出现外周淋巴结病的患者，有效识别那些需要紧急专科护理的潜在癌症患者至关重要。
我们分析了2001年至2009年间转诊至皇家马斯登医院（RMH）快速通道淋巴结诊断诊所（LNDC）的1000例连续病因不明的淋巴结病患者的大型数据集。
14%的患者被诊断为癌症。预测恶性疾病的因素为男性、年龄、锁骨上淋巴结受累及多部位受累。与癌症相关的症状中位持续时间为8周。从转诊到开始癌症治疗的中位时间为53天。83%的恶性肿瘤患者接受了细针穿刺抽吸（FNA）。FNA的敏感性和特异性有限（任何恶性肿瘤的敏感性和特异性分别为50%和87%；淋巴瘤的敏感性和特异性分别为30%和79%）。绝大多数癌症患者基于可疑的临床和超声检查结果接受了诊断性活检；FNA结果仅在4例病例中有助于确诊。
总之，我们证明由肿瘤学家主导的快速通道诊所是评估病因不明的淋巴结病患者的成功模式。我们的数据表明，在这种情况下应重新考虑常规使用FNA。
