title: Diagnostic biopsy of lymph nodes of the neck, axilla and groin: rhyme, reason or chance?
abstract: BACKGROUND
  Improving patient pathways of care is becoming increasingly important in the delivery of timely, appropriate surgical care. With this aim, we analysed the referral and management pathway of patients undergoing diagnostic superficial lymph node biopsy.
  
  
  METHODS
  A retrospective review of case notes of patients undergoing diagnostic superficial lymph node biopsy over 3 years, 1998-2000 at the Bradford Hospitals NHS Trust. Indication for surgical biopsy was based on clinical suspicion following assessment in the out-patient clinic for the majority, and arrangement of investigations as deemed appropriate. There were no clinical algorithms in use during the study period.
  
  
  RESULTS
  There was no evidence for the use of explicit protocols for referral or management. Biopsy was often delayed. Of 268 patients referred from primary care, referral was made to any of 14 hospital Department with 39% (105 of 268) attending more than one outpatient appointment, and 155 (41 of 268) attending more than one department. Eighteen percent (47 of 268) of patients were informed of their diagnosis within 6 weeks of referral and 42% (113 of 268) within 3 months of referral. Nine percent (24 of 268) underwent pre-operative fine needle aspiration cytology. Of patients with enlarged neck nodes, 29% (52/180) had examination of the upper aero-digestive tract.
  
  
  CONCLUSIONS
  The study supports the introduction of co-ordinated problem-based referral and management pathways for the management of patients with enlarged superficial lymph nodes supported by regular audits of practice.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Bradford Royal Infirmary, Bradford, UK. jim@docmoor.freeserve.co.uk
authors.forename: James W
authors.initials: JW
authors.lastname: Moor
authors.forename: Patrick
authors.initials: P
authors.lastname: Murray
authors.forename: Jane
authors.initials: J
authors.lastname: Inwood
authors.forename: David
authors.initials: D
authors.lastname: Gouldesbrough
authors.forename: Chris
authors.initials: C
authors.lastname: Bem
mesh_terms: D000328:Adult; D001365:Axilla; D001706:Biopsy / Q000706:statistics & numerical data*; D002648:Child; D004739:England; D006119:Groin; D006748:Hospital Departments; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008206:Lymphatic Diseases / Q000175:diagnosis*; D009333:Neck; D018579:Patient Selection; D018802:Patient-Centered Care / Q000458:organization & administration*; D012017:Referral and Consultation; D012189:Retrospective Studies