ANALYSIS OF DIAGNOSTIC BEHAVIOR OF NEOPLA SMS IN A SERVICE OF INTERNAL-MEDICINE

BACKGROUND: The aim of this study was to investigate the diagnostic be havior of different members of a department of internal medicine towar ds some neoplasms, analyzing the study times, reasons for suspicion an d the number of tests performed and their results. PATIENTS AND METHOD S: A retrospective review of the clinical histories of the patients ad mitted from January 1, 1992 to June 30, 1994 whose diagnosis was a new neoplasm of the digestive tract, lung cancer, cancer of unknown origi n or lymphoma was carried out. The total diagnostic study time and the different partial times were measured and confirmed. The causes leadi ng to suspicion of the neoplasms were also analyzed by groups, and fin ally the efficacy of the different diagnostic tests; either non invasi ve, oriented at the decision of the definitive test, or invasive (biop sies and fine needle aspiration puncture). RESULTS: The median total s tudy time was 13 days with no differences between the groups. The medi an time until clinical suspicion was 0 days (interquartile range 0-2), being significantly greater in the digestive neoplasms. Less than hal f of the total study time corresponded to the clinical work itself (5 vs. 8 days). Suspicion of neoplasms in 49% of the cases arose from rad iographic alteration and in 30% from clinical alterations. With regard s to diagnostic tests, the value of thorax X-ray as the first explorat ion, mainly in the lung neoplasms (82.5% of the radiographies showed a lterations), the elevated efficacy of computerized tomography, among t he non invasive tests and fine needle aspiration puncture among the in vasive tests were of note. Definitive diagnosis was achieved in 62% of the cases by biopsy and in 31% by fine needle aspiration puncture. CO NCLUSIONS: Not all the time spent in achieving diagnosis of neoplasms is attributable to clinical work, although this may be shortened. To d o so, a faster and more adequate use of the tests of greater performan ce (thorax X-ray, computerized tomography and fine needle aspiration p uncture) should be used and performed with greater coordination and co operation among the clinical technicians and physicians of the differe nt departments.