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Delay by Internists in Obtaining Diagnostic Biopsies in Patients with Suspected Cancer

Sherif S. Farag, MB; Michael D. Green, MB; George Morstyn, MB, PhD; William P. Sheridan, MB; and Richard M. Fox, MB, PhD
[+] Article, Author, and Disclosure Information

Requests for Reprints: Richard M. Fox, MB, PhD, Department of Medical Oncology, Royal Melbourne Hospital, Post Office, Victoria 3050, Australia.

Current Author Addresses: Dr. Farag: Department of Medicine, St. Vincent's Hospital, Victoria Parade, Fitzroy, Victoria 3065, Australia. Drs. Green, Sheridan, and Fox: Department of Clinical Haematology and Medical Oncology, The Royal Melbourne Hospital, Post Office, Victoria 3050, Australia.

Dr. Morstyn: Clinical and Medical Affairs, Amgen Center, 1840 Dehavilland Drive, Thousand Oaks, CA 91320-1789.

© 1992 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1992;116(6):473-478. doi:10.7326/0003-4819-116-6-473
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Objective: To investigate the degree and type of delays in performing diagnostic biopsies in medical patients with suspected malignancy.

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

Setting: Inner city teaching hospital internal medicine (nononcologic) services.

Patients: 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 valuable.

Main Outcome Measures: The number, type, and results of tests done before and after biopsy were analyzed.

Results: 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.

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


biopsy ; cancer





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