A Clinical Audit: Assessing the Diagnostic Delay of Primary Brain Tumors, Glioblastoma IDH-Wild Type and Primary CNS Lymphoma; Exploring the Use of CSF Liquid Biopsy

Abstract

Background: Diagnostic delay is a critical issue in healthcare, often leading to delayed treatment and poor patient outcomes. Diagnostic errors contribute to about 10% of patient deaths annually. Delays are very prevalent in Glioblastoma and Primary CNS Lymphoma. Both have an aggressive nature and a short survival rate, which urges for early diagnosis to ensue treatment as quick as possible. The delayed diagnosis can be attributed to tumor-specific factors such as challenging differential diagnoses, inadequate methods in achieving optimal outcomes, and the presence of confounding factors like steroid usage. Aims and Objectives: The objective of this clinical audit is to analyse patient records within an oncology unit. The primary goal is to assess the quality of practice by evaluating the standards of diagnosis and treatment. Additionally, the audit aims to pinpoint areas that require improvement at every stage of patient management, encompassing administration, symptom evaluation, and post-therapeutic measures. Based on these findings, a comprehensive plan of action will be proposed to address the identified issues effectively. Standards and Methods: In this Clinical Audit, we assessed the adherence of 10 Glioblastoma and PCNSL patients in a neuro oncology unit, to standards and guidelines set by professional medical associations. Which include World Health Organisation (WHO), National Health Service England (NHS), and European Association of Neuro-oncology (EANO). Results: Our cohort showed long diagnostic delays, minimum and maximum values of 30 and 1825 days. The sample did not show significantly longer delays compared to other PCNSL or HGG patients, all collected from the literature, with p values of 0.174 and 0.637, respectively. Conclusions: In Conclusion, Diagnostic Delay attributed to PCNSL and Glioblastoma can be pinpointed to the inadequacy of existing standards in relying solely on stereotactic biopsies for definite diagnosis when it may not be ideal for all patients at all tumor stages. A plan of action encouraging large clinical trials of CSF Liquid Biopsy is recommended with an employment of recent advances and focusing on detecting circular tumor DNA for the diagnostic insight it provides. As well as exploring its use during or post therapy to monitor the lesion and pathology. To also adhere strictly to the discouragement of steroid use for the negative prognostic factors it causes.