PO177 The two-week wait pathway for cns malignancies: examination and imaging are more important than individual symptoms

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The two-week wait (2 WW) urgent referral pathway was implemented to improve waiting times for patients with suspected central nervous system (CNS) malignancies. Studies have shown poor diagnostic yield, with only 1%–21% of CNS tumours identified via this route. We examined the utility of symptomatology, neurological examination and imaging in detecting CNS tumours.


We retrospectively studied all adults referred via the 2 WW pathway to Whipps Cross Hospital between 2007 and 2016. 252 cases were identified. Referral forms and clinical records were analysed for symptomatology, examination findings, investigations and diagnoses. We calculated positive predictive values (PPV) and tested for association with CNS tumours using Chi Squared analysis.


Headaches were the most common symptom prompting referral (54%), followed by visual disturbance (25%), nausea and vomiting (22%) and dizziness (19%). No individual symptoms were associated with a diagnosis of CNS tumour, whereas abnormal neurological examination was (PPV 12%, p=0.002). 28 (12%) CNS tumours were identified, of which 75% had prior neuroimaging (PPV 59%, p<0.001).


The 2 WW pathway has poor diagnostic utility for CNS malignancy. Only abnormal neurological examination and imaging predicted CNS tumours Recommendations include redefining referral criteria and redistribution of resources to improve early diagnosis.

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