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

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.