Deontological issues - possible misdiagnosis of cerebral metastases

Abstract

Authors analyses a number of 4588 (52, 24% over 50 years old) patients operated for cerebral tumors in the Clinic Emergency Hospital “Bagdasar-Arseni” from Bucharest, between 2000-2010, with peculiar attention to the concordance between the preoperative and postoperative diagnosis, related to the actual policy to evaluate a neurosurgical patient before surgery. 903 cases were cerebral metastases and 69,5% aged over 50 years old. In 9,7% of cases we recorded a preoperative misdiagnosis of a metastasis due to few main reasons: unavailable information about a present primitive cancer, treacherous MRI image with a single confusing appearance of a cerebral lesion, age less than 50 years old, clinical presentation and biological evaluation inconsistent with malignancy. Authors point that these situations can have serious consequences related to professional competence, deterioration of the patient-doctor relationship, increasing costs for completion of diagnosis and treatment, and inadequate information about patient’s prognosis.

Keywords

• cerebral metastases
• deontological issues
• diagnosis
• concordance