Assessing Factors in Time to Diagnosis for Head-and-Neck Lymphoma

TL;DR

This study examines factors affecting the time to diagnosis for head-and-neck lymphoma, finding that age and symptoms influence how quickly a diagnosis is made.

Contribution

The study identifies specific clinical factors influencing time to diagnosis in head-and-neck lymphoma and evaluates the role of fine-needle biopsy.

Findings

Older age is associated with longer time to diagnosis for head-and-neck lymphoma.

Non-lymphadenopathy symptoms are linked to shorter time to diagnosis.

Fine-needle biopsy by ENT does not significantly delay diagnosis after adjusting for other factors.

Abstract

Objectives

This study aimed to identify and evaluate factors influencing time to diagnosis (TTD) in head-and-neck (H&N) lymphoma, including fine-needle biopsy (FNA), and identify points of improvement in the management practice of H&N lymphoma.

Methods

This retrospective cohort study was conducted at University of Missouri, a tertiary care health system in Columbia, Missouri. Electronical medical records were reviewed to identify all patients who presented to otolaryngology and were subsequently diagnosed with lymphoma in the H&N region. Demographic and clinical factors influencing TTD, defined as time from initial clinical visit to final pathologic result, were evaluated using Cox proportional hazards multivariable regression modelling and visualized using Kaplan-Meier survival curves.

Results

Our study sample had 137 patients, most of whom presented with the primary symptom of neck mass/lymphadenopathy (81.0%). A personal history of lymphoma (HR 1.81 (1.03, 3.18); p = 0.04) and initial presenting symptoms of other than lymphadenopathy or neck mass (e.g., imaging findings, HR 2.12 (1.26, 3.59); p < 0.01) were factors associated with shorter TTD, whereas older age (HR 0.98 (0.97, 0.99) per year; p < 0.01) portends longer TTD. While FNA completed by ENT had a higher proportion of above median TTD (64.5% vs 40.0%; p < 0.01) on univariate analysis, this finding was not presenting after controlling for covariables (HR 0.93 (0.63, 1.39); p = 0.73).

Conclusion

We identified several factors associated with TTD in H&D lymphoma. FNA for lesions subsequently diagnosed as lymphoma does not clearly lengthen TTD, after controlling for confounders.

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