The Diagnostic Pathway for Intracranial Tumours: A 10-Year North Denmark Region Cohort Study

Background: The complexity of intracranial tumours, both primary (originating in the brain or its supporting tissues) and secondary (metastases from other organs), presents significant challenges for diagnostic pathways. In Denmark, specific referral criteria (RCs) guide the diagnostic process for suspected intracranial tumours. This study is aimed at evaluating adherence to and efficacy of these RCs in detecting intracranial tumours. Materials and Methods: We conducted a single-center, retrospective cohort analysis of patients from the North Denmark region referred by the general practitioner to magnetic resonance imaging (MRI) due to suspected intracranial tumours from 2013 to 2022. Medical records were reviewed to assess adherence to the Danish RC and their effectiveness in detecting tumours. Results and Discussion: Among 2055 patients, intracranial tumours were identified in 207 cases (10%). Of these, 157 patients (11%) met the RC, while 50 patients (9%) did not meet the criteria. In the adherence group, tumour detection rates were 25% in patients with monosymptomatic focal neurological deficits, 20% with personality changes, 11% with seizures, 20% with headaches, and 24% in those presenting with more than one symptom. Regardless of RC adherence, intracranial tumours were identified in 43 out of 833 patients with headaches (5%). A prior history of cancer was documented in 253 cases, with a 12% tumour detection rate in these patients. Conclusion: In summary, intracranial tumour was detected in about 1 out of 10 imaging studies when following the Danish RCs for the diagnostic pathway. Monosymptomatic headache was a frequent RC and intracranial tumour was found in 5% of these patients. A medical history of tumour slightly increased the detection rate of intracranial tumours.