Servicio de Otorrinolaringología, Parc Taulí Hospital Universitari, Sabadell, Barcelona, Spain.
Servicio de Otorrinolaringología, Parc Taulí Hospital Universitari, Sabadell, Barcelona, Spain.
Acta Otorrinolaringol Esp (Engl Ed). 2021 Sep-Oct;72(5):271-279. doi: 10.1016/j.otoeng.2020.06.008.
Given the epidemiological knowledge of squamous cell carcinomas of the head and neck (SCHN), the prognosis in survival according to the staging at diagnosis and the absence of screening programmes that have proven cost-effective, we undertook a rapid diagnosis programme. The objective of this study was to analyse whether a rapid diagnostic programme (RDP) to be used by General Practitioners (GP) would achieve a change in the proportion of diagnoses in early versus late stages in these tumours.
A prospective observational study of patients diagnosed with a tumour of ENT location in our centre, was carried out for 24 consecutive months. A "suspicion algorithm" was designed and we established a rapid remission route for these patients. The data obtained (age, sex, toxic substance consumption, initial manifestations, tumour location and extension) were compared with the data of the patients in our ENT Service database diagnosed in the four years prior to the start of the study.
199 patients were included, and 82 ENT tumours diagnosed. The GPs sent to the Hospital via the RDP a total of 136 patients and 35 (26.1%) had a tumour. However, most of the tumours diagnosed in this period by our ENT Department (47 patients, 57.3% of all tumours diagnosed), were not suspected by the GP and were not sent via the RDP. Of the patients, 27% were diagnosed in stages I and II, and 73% in stages II and IV, there were no significant differences with the control group. The most frequent initial signs and symptoms were dysphonia, cervical mass and dysphagia, the relationship between initial symptom and stage at the moment of diagnosis was analysed, and in neither case did we obtain any significant variation.
The implementation of a rapid diagnosis pathway for patients who, according to the algorithm created, had a suspected head and neck cancer, has not led to an increase in the diagnosis of these tumours in early stages or a decrease in diagnoses in advanced stages.
鉴于头颈部鳞状细胞癌（SCHN）的流行病学知识，根据诊断时的分期和缺乏经过验证具有成本效益的筛查计划，预后生存率存在差异，我们开展了一项快速诊断计划。本研究的目的是分析由全科医生（GP）使用的快速诊断计划（RDP）是否会改变这些肿瘤的早期和晚期诊断比例。
对 24 个月内连续在我们中心诊断为耳鼻喉部位肿瘤的患者进行前瞻性观察研究。设计了一个“怀疑算法”，并为这些患者建立了快速缓解途径。比较了（年龄、性别、毒物消耗、初始表现、肿瘤位置和扩展）获得的数据与研究开始前四年我们耳鼻喉科服务数据库中诊断的患者数据。
共纳入 199 例患者，诊断出 82 例 ENT 肿瘤。GP 通过 RDP 共向医院转诊 136 例患者，其中 35 例（26.1%）患有肿瘤。然而，我们耳鼻喉科在此期间诊断的大多数肿瘤（47 例，所有诊断肿瘤的 57.3%）并未被 GP 怀疑，也未通过 RDP 转诊。患者中 27%诊断为 I 期和 II 期，73%诊断为 II 期和 IV 期，与对照组相比无显著差异。最常见的首发症状和体征是声音嘶哑、颈块和吞咽困难，分析了首发症状与诊断时分期的关系，但在任何情况下都没有发现任何显著差异。
对于根据创建的算法怀疑患有头颈部癌症的患者实施快速诊断途径，并未导致这些肿瘤的早期诊断增加或晚期诊断减少。
