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Delays in Malignant Neck Mass Diagnosis: Missed Opportunities in Clinical Decision-Making
Jacob Edward Hoerter1,2, Peter Debbaneh1, Abhishek D Doshi3
1Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Introduction:
Neck masses are a common presenting symptom for head and neck cancers and lymphomas. However, the diagnostic pathway for these malignancies remains underexplored.
Methods:
The authors reviewed a subset of adult patients with neck masses ultimately diagnosed as malignant. Clinical decisions by primary care physicians (PCPs) and otolaryngologists were assessed. The authors evaluated diagnostic time intervals and biopsy diagnostic rates.
Results:
Among 192 patients, the median time to diagnosis was 21 days. Antibiotics prescribed by PCPs were associated with a 20-day delay (P < .001), while PCP-ordered imaging led to a 4-day delay (P < .001). Initial biopsy methods included fine needle aspiration ( 70%), core needle biopsy (28%), and excision (2%), with diagnostic success rates of 56%, 74%, and 100%, respectively (P = .017). Eighteen percent of patients followed the most streamlined diagnostic pathway and experienced a median total diagnostic interval of 6 days.
Conclusions:
Most patients did not undergo the most optimal diagnostic process. Antibiotic use, PCP-ordered imaging, and delayed or unsuccessful biopsies were common contributors to delay.
