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OBJECTIVE: To create a care pathway for patients with a newly detected brain tumor, by examining common diagnostic pathways for patients diagnosed with a primary brain tumor or a central nervous system metastasis.

MATERIALS AND METHODS: All patients diagnosed atMGH between 1/1/95 and 12/31/97 with a primary brain tumor or a central nervous system metastasis were studied. Only patients who displayed one or two brain lesions and presented to the MGH emergency ward or transferred in from another emergency ward were included in the study. Clinical characteristics, use and results of radiological testing, and final diagnostic procedures were evaluated.

RESULTS: Forty-eight patients were selected for the study. The most common ancillary test performed was a chest x-ray; 97.9% of the patients received a chest x-ray, while only 18.8% received a chest CT. None of the chest CT examinations showed a diagnostically significant different from the chest x-ray. Other ancillary scanning was done infrequently.

DISCUSSION: A relatively small proportion of patients with a newly detected brain lesion received any type of ancillary testing beyond a chest x-ray. A chest x-ray appeared to change the biopsy site from the brain to another site in about 50% of the cases. Not enough chest CT examinations were done to determine their effectiveness. However, the resuhs seem to indicate that the preliminary diagnosis of the admitting physician is not necessarily based upon the results of a chest x-ray or other ancillary testing.

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