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. 2018 Aug 14:18:19.
doi: 10.1186/s12878-018-0109-0. eCollection 2018.

Rapid access clinic for unexplained lymphadenopathy and suspected malignancy: prospective analysis of 1000 patients

Andrea Kühnl  1 , David Cunningham  1 , Margaret Hutka  1 , Clare Peckitt  2 , Hamoun Rozati  1 , Federica Morano  1 , Irene Chong  1 , Angela Gillbanks  1 , Andrew Wotherspoon  3 , Michelle Harris  1 , Tracey Murray  1 , Ian Chau  1
Affiliations

Rapid access clinic for unexplained lymphadenopathy and suspected malignancy: prospective analysis of 1000 patients

Andrea Kühnl et al. BMC Hematol. .

Abstract

Background: In patients presenting with peripheral lymphadenopathy, it is critical to effectively identify those with underlying cancer who require urgent specialist care.

Methods: 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).

Results: 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.

Conclusions: 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.

Keywords: Cancer diagnosis; Lymphadenopathy; Rapid access clinic.

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Conflict of interest statement

We received approval from the Royal Marsden Committee for Clinical Research to obtain patient records and perform this analysis (CCR1575). Only data already available on electronic patient records was used. Since anonymised data was collected retrospectively and patients’ management was not influenced by the data, a specific consent was not required.Not applicableD.C. has received research funding from Amgen, Astra Zeneca, Bayer, Celgene, Medimmune, Merrimack, Merck Serono and Sanofi. The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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