Delay by internists in obtaining diagnostic biopsies in patients with suspected cancer

To investigate the degree and type of delays in performing diagnostic biopsies in medical patients with suspected malignancy.

Retrospective survey of clinical histories of patients referred between January 1985 and March 1989.

Inner city teaching hospital internal medicine (non-oncologic) services.

Patients with gastrointestinal and lung cancers, adenocarcinoma of unknown primary site, and lymphomas were referred as inpatients by internists. Two hundred fifty-five patients were eligible, and 177 were evaluable.

The number, type, and results of tests done before and after biopsy were analyzed.

In 67% of patients the biopsied lesion was detected by the second day of evaluation; however, there was an 8- to 10-day delay before a biopsy was done. This delay was consistent across the four malignancy groups studied. Although logistic and other unavoidable delays occurred in 40% of the cases, in 60% delays could only be attributed to continued, frequently low yield, noninvasive tests. An average of 3.3 tests were made per patient, with only 24% leading to a definitive biopsy.

Because of the performance of many other tests, a substantial delay exists in proceeding to biopsy during the diagnosis of cancer by internists.