ArticleBMC cancer2019
The determinants and impact of diagnostic delay in lymphoma in a TB and HIV endemic setting.
Article in BMC cancer, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
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Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it, 33 citations in OpenAlex.
- Pooled it
- In the South African setting, HIV-associated Burkitt lymphoma is associated with frequent leukaemic presentation, complex cytogenetic karyotypes, and adverse clinical outcomes.Annals of hematology · 2020Trial
- Access to diagnosis using liquid biopsy (ADLiB): Identifying lymphoma in a tuberculosis-endemic setting.HemaSphere · 2026Article
- Incidence rates of non-Hodgkin lymphoma subtypes among Black Africans with and without HIV in South Africa: a national registry-based study.The Lancet regional health. Africa · 2026Article
- Liquid biopsy for the diagnosis of EBV-positive Burkitt's lymphoma in endemic areas.Nature medicine · 2026Article
- Article
- Point-of-care core needle biopsy pathway for early diagnosis of lymph node masses: comparative costing of a scalable pathway.Health economics review · 2026Article
- HIV-Associated Lymphomas: Updates from Pathogenesis to Treatment Strategies.Current HIV research · 2026Review
- Delayed diagnosis of selected thoracic and mediastinal conditions in young adults: a focused narrative review of clinical pitfalls, cognitive biases, and system barriers.Frontiers in medicine · 2026Review
- Early-stage Hodgkin lymphoma in Cape Town, South Africa: prognostic risk factors at diagnosis and treatment outcomes.BMC cancer · 2025Article
- The impact of tuberculosis misdiagnosis in Hodgkin lymphoma patients.The Indian journal of medical research · 2025Article
- Article
- Article
- Lymphoma in Sub-Saharan Africa: a scoping review of the epidemiology, treatment challenges, and patient pathways.Cancer causes & control : CCC · 2025Article
- Diagnostic use of abdominal ultrasound in detecting extrapulmonary tuberculosis or lymphoma in an HIV-endemic region.Southern African journal of HIV medicine · 2025Article
- The diagnostic pathway to lymph node excision biopsy in an HIV- and tuberculosis-endemic region.Southern African journal of HIV medicine · 2025Article
- Treatment Patterns and Clinical Outcomes in Patients with Hodgkin Lymphoma from Saudi Arabia, Türkiye, and South Africa: Subgroup Analysis from the International Multicenter Retrospective B-HOLISTIC StudyTurkish journal of haematology : official journal of Turkish Society of Haematology · 2024Article
- Treatment delays in children and young adults with lymphoma: a report from an East Africa lymphoma cohort study.Blood advances · 2023Article
- Empirical Antitubercular Treatment for Lymphadenopathy: Are We Missing Lymphoma?Indian journal of pediatrics · 2023Article
- What causes delays in diagnosing blood cancers? A rapid review of the evidence.Primary health care research & development · 2023Review
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundLittle is known about the pathway to diagnosis of lymphoma in Sub-Saharan Africa, despite the increased risk of lymphoma in people living with HIV (PLHIV). The challenges of diagnosis in this setting include diagnostic confusion with extrapulmonary tuberculosis (EPTB), which commonly causes lymphadenopathy in PLHIV.
methodsWe analysed the time to diagnosis and treatment in patients using predetermined time intervals. Univariate and multivariable analyses were performed to determine the relationship between patient and disease-specific variables with delays to diagnosis. We were particularly interested in the impact of HIV, empiric tuberculosis therapy and fine-needle aspirate for cytology (FNAC) in contributing to delay.
resultsPatients (n = 163), 29% HIV-infected, waited a median of 4 weeks before seeking medical attention. It took a median of 7 weeks for the diagnosis of lymphoma to be made from the time the patient sought medical attention, termed the healthcare practitioner interval. In multivariable logistic regression analysis, diagnostic delay > 6 weeks was associated with late-stage disease (OR 2.3, 95% CI 1.1-5.2) and Hodgkin lymphoma (HL) (OR 3.0, 95% CI 1.1-8.0). HIV status was not associated with diagnostic delay (OR 0.9, 95% CI 0.3-2.2). The median time to diagnosis was a median of 4 weeks longer for patients on tuberculous (TB) therapy (n = 16, p = 0.28) and patients who underwent an FNAC (n = 63, p = 0.04). Where FNAC was performed, it was diagnostic for lymphoma in only 11%. Diagnostic delay was not associated with overall survival.
conclusionsTime-to-diagnosis of lymphoma in South Africa was similar to that reported from high-income countries and shows significant periods of delay between the onset of symptoms to diagnosis and treatment. The longest period of delay was in the health practitioner interval. Education regarding the significance of lymphadenopathy for both patients and health care practitioners and appropriate investigative steps preferably by best-practice algorithms specific to TB-endemic areas are needed to shorten the time-to-diagnosis of lymphoma.
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