scholarly journals An Audit of Urology Two-Week Wait Referrals in a Large Teaching Hospital in England

2009 ◽  
Vol 91 (4) ◽  
pp. 310-312 ◽  
Author(s):  
Anup Mathew ◽  
KM Desai
Keyword(s):  
Testicular Cancer ◽  
Cancer Detection ◽  
Detection Rate ◽  
Specific Antigen ◽  
Cancer Detection Rate ◽  
Department Of Health ◽  
Urological Cancers ◽  
Retrospective Audit ◽  
Number Of Patients ◽  
The Uk

INTRODUCTION Two week wait referral guidelines have been published by the UK Department of Health for suspected urological cancers. Concordance to these guidelines is variable. Our objectives were to assess the incidence of urological malignancy and the proportion of inappropriate referrals in the two-week wait pathway. PATIENTS AND METHODS Retrospective audit of all two-week wait referrals to the urology department over 6 months. Inappropriate referrals were those not satisfying the referral criteria, but referred under the two-week wait system. Detection rates were calculated for each referral criterion based on diagnosis obtained from histology, imaging reports and clinic letters. RESULTS Incidence of cancer was 90 of 400 two-week wait referrals (23%). The cancer-detection rate based on reasons for referral ranged from 50 of 122 (41%) for elevated prostate-specific antigen levels to 2 of 56 (4%) for scrotal lumps; 42 (11%) referrals were inappropriate. CONCLUSIONS The overall cancer-detection rate is acceptable. Most inappropriate referrals were for long-standing symptoms and non-specific testicular/scrotal symptoms. The testicular cancer detection rate raises questions about the two-week wait guidelines. Providing general practitioners with fast-track scrotal ultrasound and revising the guideline may reduce the disproportionately high number of patients referred with suspected testicular cancer. Other inappropriate referrals are a cause for concern as they add to the workload of the ‘urgent-referral’ pathway. Urological cancers (those involving the prostate, testis, penis, urethra, bladder, ureters and kidneys) accounted for 15.4% of all new cancers in England, 1 and 12.1% of deaths from cancer, 2 in England and Wales, in 2004. The two-week wait referral guidelines published by the UK Department of Health for suspected urological cancers 3 are summarised in Table 1 . NHS trusts and SHAs are encouraged to carry out clinical audits of suspected cancer referrals to generate further information. 4 There is wide variation among various centres and regions in the concordance of general practitioner (GP) referrals based on these guidelines, and also the rate of cancers detected based on the two-week wait system. [Table: see text] The objectives of this audit were to calculate: (i) the rate of detection of cancers among the two-week wait referrals; (ii) the rate of detection of cancers based on the reason for referral; and (iii) the proportion of inappropriate referrals.

scholarly journals 1274 Impact of Covid 19 on Urgent Suspicion of GI Cancer Referral in a District General Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Barman ◽  
H J Ng ◽  
S Teo ◽  
E M Blaney ◽  
O Mansfield
Keyword(s):  
Cancer Detection ◽  
Detection Rate ◽  
District General Hospital ◽  
Cancer Detection Rate ◽  
P Value ◽  
High Grade ◽  
Consistent Finding ◽  
Number Of Patients ◽  
The Uk ◽  
The Impact

Abstract Aim Endoscopy services across United Kingdom were affected significantly since March 2020 due to Covid-19 pandemic. Services were reduced and were more selective. We aim to compare the impact on duration between referral to colonoscopy and the detection rate of pathology between February (pre- Covid) and August (Covid impacted) 2020. Method Data was analysed from a prospectively maintained database of patients referred for colonoscopy to Royal Alexandra Hospital, Scotland. Patients underwent colonoscopy in month of February and August 2020 were included. Bowel screening patients were excluded. Positive findings included diverticulosis, colitis, polyp and adenocarcinoma. P value of < 0.05 was considered significant. Results Total number of patients included was 97 (55 in February, 42 in August). Median age was 61 and 69 years, respectively. Mean duration from referral to colonoscopy were 4 weeks in February and 7 weeks in August. qFIT test were found raised in 50.9% in February and 57.1% in August with positive findings of 47.3% in February and 66.7% in August. 46.4% in February and 16.7% in August had raised qFIT but normal findings (p < 0.05). Two high grade dysplasia polyps and two adenocarcinomas were identified in February, none found in August. Conclusions Covid-19 pandemic has disrupted the endoscopic services prolonging the duration from referral to colonoscopy. qFIT test is more heavily relied to prioritise urgent colonoscopies resulting in more positive findings on colonoscopy. Cancer detection rate has reduced which is a consistent finding as the UK national endoscopy study. Massive efforts are needed to restore endoscopy services.

scholarly journals EP.FRI.368Impact of Covid 19 on Urgent Suspicion of GI Cancer Referral in a District General Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Sowrav Barman ◽  
Hwei Jene Ng ◽  
Serene Teo ◽  
Eimear Blaney ◽  
Olivia Mansfield
Keyword(s):  
Cancer Detection ◽  
Detection Rate ◽  
District General Hospital ◽  
Cancer Detection Rate ◽  
P Value ◽  
High Grade ◽  
Consistent Finding ◽  
Number Of Patients ◽  
The Uk ◽  
The Impact

Abstract Aim Endoscopy services across United Kingdom were affected significantly since March 2020 due to Covid-19 pandemic. Services were reduced and were more selective. We aim to compare the impact on duration between referral to colonoscopy and the detection rate of pathology between February (pre- Covid) and August (Covid-impacted) 2020.    Methods Data was analysed from a prospectively maintained database of patients referred for colonoscopy to Royal Alexandra Hospital, Scotland. Patients underwent colonoscopy in month of February and August 2020 were included. Bowel screening patients were excluded. Positive findings included diverticulosis, colitis, polyp and adenocarcinoma. P value of < 0.05 was considered significant. Results Total number of patients included was 97 (55 in February, 42 in August). Median age was 61 and 69 years respectively. Mean duration from referral to colonoscopy were 4 weeks in February and 7 weeks in August. qFIT test were found raised in 50.9% in February and 57.1% in August with positive findings of 47.3% in February and 66.7% in August. 46.4% in February and 16.7% in August had raised qFIT but normal findings (p < 0.05). Two high grade dysplasia polyps and two adenocarcinomas were identified in February, none found in August.   Conclusion Covid-19 pandemic has disrupted the endoscopic services prolonging the duration from referral to colonoscopy. qFIT test is more heavily relied to prioritise urgent colonoscopies resulting in more positive findings on colonoscopy. Cancer detection rate has reduced which is a consistent finding as the UK national endoscopy study. Massive efforts are needed to restore endoscopy services. 

scholarly journals Magnetic resonance/ultrasound fusion targeted biopsy of the prostate can be improved by adding systematic biopsy

2021 ◽  
Author(s):  
Victor Mihail Cauni ◽  
Dan Stanescu ◽  
Florin Tanase ◽  
Bogdan Mihai ◽  
Cristian Persu
Keyword(s):  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Cancer Detection ◽  
Detection Rate ◽  
Specific Antigen ◽  
Cancer Detection Rate ◽  
Targeted Biopsy ◽  
Detection Rates ◽  
Clinically Significant ◽  
Systematic Biopsy

Aim: Magnetic resonance/ ultrasound fusion targeted biopsy (Tbs) is widely used for diagnosing prostate cancer (PCa). The aim of our study was to compare the cancer detection rate (CDR) and the clinically significant prostate cancer detection rate (csPCa) of the magnetic resonance/ultrasound fusion targeted biopsy with those of the standard systematic biopsy (Sbs) and of the combination of both techniques.Material and methods: A total of 182 patients underwent magnetic resonance/ultrasound fusion Tbs on the prostate for PCa suspicion based on multiparametric magnetic resonance imaging (mMRI) detection of lesions with PI-RADSv2 score ≥3. A total of 78 patients had prior negative biopsies. Tb was performed by taking 2-4 cores from each suspected lesion, followed by Sb with 12 cores. We evaluated the overall detection rate of PCa and clinically significant prostate cancer, defined as any PCa with Gleason score ≥3+4.Results: Median prostate specific antigen (PSA) level pre-biopsy was 7.4 ng/ml and median free-PSA/PSA ratio was 10.2%. Patient median age was 62 years old. PIRADSv2 score was 3 in 54 cases, 4 in 96 cases and 5 in 32 cases. PI-RADS-dependent detection rate of Tbs for scores 3, 4 and 5 was 25.9%, 65.6% and 84.4%, respectively, with csPCa detection rates of 24.1%, 54.2%, and 71.9%. Overall detection rate was 57.1% for Tbs, which increased to 60.4% by adding Sbs results. Detection rate for clinically significant prostate cancer (csPCa) was 48.4% and increased to 51.1% by adding Sbs. Overall detection rate for repeated biopsy was 50% and 68.3% for biopsy in naïve patients. Sbs detection rate was 55.5%, 8 patients having a negative biopsy on Tbs.Conclusions: When Tbs is considered due to a PI-RADS ≥3 lesion on mMRI, combined Tbs + Sbs increases the overall CDR and csPCa detection rates.

Integrating breast cancer screening into a cervical cancer screening program in three rural districts in Rwanda.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2025-2025
Author(s):  
Lydia E. Pace ◽  
Jean Marie Vianney Dusengimana ◽  
Jean Paul Balinda ◽  
Origene Benewe ◽  
Vestine Rugema ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Cancer Detection ◽  
Detection Rate ◽  
Cancer Detection Rate ◽  
System Capacity ◽  
District Hospitals ◽  
Number Of Patients

2025 Background: In low-income countries where mammography is not widely available, optimal strategies to facilitate earlier breast cancer detection are not known. We previously conducted a cluster randomized clinical trial of clinician trainings in Burera District in rural Rwanda to facilitate earlier diagnosis among symptomatic women; 1.3% of women evaluated at intervention health centers (HCs) were diagnosed with cancer. Early stage breast cancer incidence was higher in intervention areas. Subsequently, Rwanda Biomedical Centre, Rwanda’s national health implementation agency, adapted the program in 3 other districts, offering screening clinical breast exams (CBE) to all women aged 30-50 years receiving cervical cancer screening and any other woman requesting CBE. A navigator facilitated patient tracking. We sought to examine patient volume, service provision and cancer detection rate in the adapted program. Methods: We abstracted data from weekly HC reports, facility registries, and the referral hospital’s electronic medical record to determine numbers of patients seen, referrals made, biopsies, and cancer diagnoses from July 2018-December 2019. Results: CBE was performed at 17,239 visits in Rwamagana, Rubavu and Kirehe Districts (total population 1.34 million) over 18, 17 and 7 months of program implementation respectively. At 722 visits (4.2%), CBE was abnormal. 571 patients were referred to district hospitals (DH); their average age was 35 years. Of those referred, 388 (68.0%) were seen at DH; 32% were not. Of those seen, 142 (36.6%) were referred to a referral facility; 121 of those referred (85.2%) actually went to the referral facility. Eighty-eight were recommended to have biopsies, 83 (94.3%) had biopsies, and 29 (34.9% of those biopsied; 0.17% of HC visits) were diagnosed with breast cancer. Conclusions: Integrating CBE screening into organized cervical cancer screening in rural Rwandan HCs led to a large number of patients receiving CBE. As expected, patients were young and the cancer detection rate was much lower than in a trial focused on symptomatic women. Even with navigation efforts, loss-to-follow-up was high. Analyses of stage, outcomes, patient and provider experience and cost are planned to characterize CBE screening’s benefits and harms in Rwanda. However, these findings suggest building health system capacity to facilitate referrals and retain patients in care are needed prior to further screening scaleup. In the interim, early diagnosis programs targeting symptomatic women may be more efficient and feasible.

scholarly journals Redefining Serum PSA Cut-off in Indian Population to Avoid Unnecessary Biopsies - A Descriptive Study

2021 ◽  
Author(s):  
Javangula Venkata Surya Prakash ◽  
Thiruvarul PV ◽  
Vetrichandar Sattanathan ◽  
Krishnan Vembu Arasi ◽  
ArunKumar Paranjothi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Prostate Biopsy ◽  
Detection Rate ◽  
Indian Population ◽  
Specific Antigen ◽  
Cancer Detection Rate ◽  
Asian Countries ◽  
Western Countries ◽  
Guided Biopsy

Abstract INTRODUCTION: Prostate cancer is the second most common cancer diagnosed in men with an estimated 1.2 million diagnoses worldwide. The incidence of Prostate cancer is higher in western countries and low in Asian countries. The need for prostate biopsy is based on PSA levels. The general cut off PSA value for the Indian population is 4.0 ng/mL. The reported cancer detection rate of TRUS-guided biopsies is around 30 percent in western countries and lesser in Asian countries, including India, particularly for serum PSA values less than 20 ng/mL indicating that many of the Indian patients are subjected to unnecessary biopsy which adds up to distress to these patients.PURPOSE: To determine the cancer detection rate of TRUS-guided prostate biopsy in the Indian population at different serum Prostate-Specific Antigen levels and determine a PSA cut-off level to avoid unnecessary biopsies.MATERIALS AND METHODS:All symptomatic patients who underwent TRUS guided biopsy for raised serum PSA levels between 4 - 20 ng/mL were included. The patients were categorized into four groups corresponding to the PSA levels ranging between 4-6 ng/mL, 6- 8 ng/mL, 8-10 ng/mL, and 10-20 ng/mL respectively, and cancer detection rate in each group were statistically analyzed.RESULTS:The sensitivity, specificity, and positive predictive value of TRUS guided biopsy are 75%, 95%, and 98% respectively in our study. The overall cancer detection rate of TRUS biopsy in our series was 18.4%. The PSA cut-off to do biopsy was derived by ROC curve as 8.9 ng/ml for all the men. CONCLUSION: The PSA cut-off of 4.0 ng/mL is currently used as an indication for biopsy among men of all ages in the Indian population. We recommend a raise in cut-off to 8.9 ng/mL to avoid unnecessary TRUS-guided biopsies in the Indian population.

scholarly journals Comparison of 8, 10, 12, 16, 20 cores prostate biopsies in determination of prostate cancer and importance of prostate volume

2014 ◽  
Vol 8 (1-2) ◽  
pp. 81 ◽  
Author(s):  
Cavit Ceylan ◽  
Omer Gokhan Doluoglu ◽  
Erdogan Aglamis ◽  
Ozkan Baytok
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Detection Rate ◽  
Prostate Volume ◽  
Multiple Logistic Regression Analysis ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Cancer Detection Rate ◽  
The Core ◽  
Prostate Biopsies

Introduction: In this study, we evaluate the relationship between increasing core numbers and cancer detection rate.Methods: We included 1120 patients with prostate-specific antigen levels ≤20 ng/mL and/or suspicious digital rectal examination findings in this study. All patients had a first-time prostate biopsy and 8, 10, 12, 16, and 20 core biopsies were taken and examined in different groups during the study. Multiple logistic regression analysis was made to reach the factor affecting the cancer detection rate between the patients with and without cancer. A p < 0.05 was considered statistically significant.Results: Out of 1120 patients, 221 (19.7%) had prostate cancer. Again of the total 1120 patients, 8 core biopsies were taken from 229 (20.4%); 10 core biopsies from 473 (42.2%); 12 core biopsies from 100 (8.9%); 16 core biopsies from 140 (12.5%); and 20 core biopsies from 178 (15.9%) patients. The increase in the core number increased the cancer detection rate by 1.06 times (p = 0.008).Conclusions: As long as prostate volume increases, increasing the core number elevates the cancer detection rate. Thus, the rate of missed cancer will be reduced and the rates of unnecessary repetitive biopsy decreases.

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