Gobbo Margherita, Ottaviani Giulia, Rupel Katia, Zoi Valentina, Di Lenarda Roberto, Biasotto Matteo, Poropat Augusto
Unit of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy -
Unit of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
Minerva Stomatol. 2020 Apr;69(2):95-99. doi: 10.23736/S0026-4970.19.04212-2.
The objective of this retrospective study was to characterize the outpatient oral medicine referral pattern for tongue lesions with particular emphasis on cancer.
Records of patients referred to the Oral Medicine department for any tongue lesions needing biopsy between 2009 and 2016 were retrospectively analyzed. All cases diagnosed as tongue cancer were screened for medical history, referral pattern, treatment/diagnosis/follow-up.
Among 266 patients, 39 were diagnosed with cancer, 43.6% were smokers and 10.3% alcohol consumers, 38.5% felt pain, 53.8% noticed the lesion or felt its presence, 46.2% were referred from another specialist. For people aware or informed of the lesion. the mean time waited before consultation was 7.9 months. In 53.8% of cases, narrow-band-imaging guided the biopsy. In 29 patients, biopsy was performed the day of the visit. Patients were referred from dentists (42.1%), Primary-care-Physician (10.5%), Emergency-Dental-Unit (7.9%), Radiotherapist (7.9%), Otolaryngologist (7.9%), Dermatologist (26%), infectious diseases unit (2.6%), auto-referral in 18.4%. Lesion was defined by referring doctor as "suspicious" (13.1%), white (10.5%), vegentans (5.3%), Lichen-like (5.3%), ulcerative (2.6%), Tumoral (26.3%), Bollous (2.6%). An unweighted Kappa Value of 0.024, assessed low concordance between referral diagnosis and diagnosis performed by the Oral Medicine specialist before the biopsy.
Patients are not always aware of the risk of oral cancer. Accurate information should be provided to patients as well as to specialists rather than just dentists as regard as the risk factors for oral cancer, the importance of referral to specialized departments and timing. The use of new technologies should be widespread.
本回顾性研究的目的是描述舌部病变的门诊口腔医学转诊模式，尤其关注癌症。
回顾性分析2009年至2016年间因任何需要活检的舌部病变转诊至口腔医学科的患者记录。对所有诊断为舌癌的病例进行病史、转诊模式、治疗/诊断/随访筛查。
在266例患者中，39例被诊断为癌症，43.6%为吸烟者，10.3%为饮酒者，38.5%感到疼痛，53.8%注意到病变或感觉到其存在，46.2%由另一位专科医生转诊。对于知晓或被告知病变的人，咨询前平均等待时间为7.9个月。在53.8%的病例中，窄带成像引导活检。29例患者在就诊当天进行了活检。患者转诊自牙医（42.1%）、初级保健医生（10.5%）、急诊牙科单元（7.9%）、放射治疗师（7.9%）、耳鼻喉科医生（7.9%）、皮肤科医生（26%）、传染病科（2.6%），18.4%为自我转诊。转诊医生将病变定义为“可疑”（13.1%）、白色（10.5%）、疣状（5.3%）、苔藓样（5.3%）、溃疡性（2.6%）、肿瘤性（26.3%）、水疱性（2.6%）。转诊诊断与口腔医学专科医生在活检前进行的诊断之间的未加权Kappa值为0.024，评估为低一致性。
患者并非总是意识到口腔癌的风险。应向患者以及专科医生（而非仅牙医）提供关于口腔癌风险因素、转诊至专科部门的重要性和时机的准确信息。新技术的使用应广泛普及。
