Surgeon-performed ultrasound in a head and neck surgical oncology clinic: saving time and improving patient care

Kwok, Matthew Ming Kei; Choong, Keith Wai Keong; Virk, Jagdeep Singh; Magarey, Matthew; Flatman, Samuel

doi:10.1007/s00405-020-06344-6

Cited by 4 publications

(6 citation statements)

References 22 publications

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“…However, it may also facilitate earlier patient contact, may use fewer outpatient resources, and may allow a more efficient route to targeted investigations in select patients. 6 , 7 Patients with cancer may be diagnosed faster, and those without cancer may be reassured more efficiently; this provides potential benefits to patients and health care services alike. However, remote triage was novel to most clinicians at the time it was widely adopted, and the safety of this practice in these patients had not been established.…”

Section: Introductionmentioning

confidence: 99%

Remote triage incorporating symptom‐based risk stratification for suspected head and neck cancer referrals: A prospective population‐based study

Hardman

Tikka

Paleri

2021

Cancer

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BACKGROUND:Remote triage for suspected head and neck cancer (HNC) referrals was adopted by many institutions during the initial peak of the coronavirus disease 2019 pandemic. Its safety in this population has not been established. METHODS: A 16-week, prospective, multicenter national service evaluation was started on March 23, 2020. Suspected HNC referrals undergoing remote triage in UK secondary care centers were identified and followed up for a minimum of 6 months to record the cancer status. Triage was supported by risk stratification using a validated calculator. RESULTS: Data for 4568 cases were submitted by 41 centers serving a population of approximately 26 million. These represented 14.1% of the predicted maximum referrals for this population outside of pandemic times, and this gave the study a margin of error of 1.34% at 95% confidence. Completed 6-month follow-up data were available for 99.8% with an overall cancer rate of 5.6% (254 of 4557). The rates of triage were as follows: urgent imaging investigation, 25.4% (n = 1156); urgent face-to-face review, 27.8%; (n = 1268); assessment deferral, 30.3% (n = 1382); and discharge, 16.4% (n = 749). The corresponding missed cancers rates were 0.5% (5 of 1048), 0.3% (3 of 1149), 0.9% (12 of 1382), and 0.9% (7 of 747; P = .15). The negative predictive value for a nonurgent triage outcome and no cancer diagnosis was 99.1%. Overall harm was reported in 0.24% (11 of 4557) and was highest for deferred assessments (0.58%; 8 of 1382). CONCLUSIONS: Remote triage, incorporating risk stratification, may facilitate targeted investigations for higher risk patients and prevent unnecessary hospital attendance for lower risk patients. The risk of harm is low and may be reduced further with appropriate safety netting of deferred appointments. Cancer 2021;0:1-13.

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Section: Introductionmentioning

confidence: 99%

Remote triage incorporating symptom‐based risk stratification for suspected head and neck cancer referrals: A prospective population‐based study

Hardman

Tikka

Paleri

2021

Cancer

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“…An analysis of pretreatment wait times for head and neck cancer patients in Western Australia determined that 29% of mean total wait time was attributed to the period from referral to biopsy. 8 Comparisons between SUS-FNA and radiologist-performed US-FNA for thyroid nodules have demonstrated a significant reduction in time to reach definitive treatment decision and time to surgery 1,2,9,10 ; we propose that SUS-FNA should be similarly adopted by surgeons in lateral neck masses.…”

Section: Discussionmentioning

confidence: 93%

“…Although traditionally performed by radiologists, surgeon-performed US-FNA has been shown to reduce hospital visits and time to diagnosis and treatment. 1,2 The surgeon is also afforded the ability to view real-time imaging of lesions and characterize aspects of the lesion and anatomy that can contribute to surgical decision making. 3 The majority of available literature appraising surgeon-performed ultrasound has focused on its utility in thyroid pathology, however there are significant benefits of surgeon-performed ultrasound FNA (SUS-FNA) in lateral neck masses.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic adequacy and accuracy of surgeon‐performed ultrasound guided fine needle aspiration in lateral neck masses

Blom,

Magarey,

Flatman

2024

ANZ Journal of Surgery

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BackgroundSurgeon‐performed ultrasound guided fine needle aspiration (SUS‐FNA) reduces the time to diagnosis and treatment of head and neck pathology. Although it has been validated in the investigation of thyroid pathology, there is a paucity of evidence to support its use in lateral neck masses. This study aims to determine the accuracy and adequacy of SUS‐FNA in the investigation of lateral neck masses.MethodsA retrospective cohort analysis was performed of patients who underwent a SUS‐FNA for lateral neck mass between June 2018 and October 2022 at a single institution. Pathologist reports were reviewed to determine the rate of FNA sample adequacy. A comparison was made between FNA cytology results and final histopathological diagnosis following surgical excision in a subset of patients to determine FNA accuracy.ResultsA total of 110 SUS‐FNAs were performed on lateral neck masses. Diagnostic adequacy of SUS‐FNA was determined to be 91% (100/110). When analysing the subset of patients who proceeded to surgical excision, the diagnostic accuracy of SUS‐FNA was determined to be 88% (38/43).ConclusionSUS‐FNA results in high adequacy rates with good diagnostic accuracy in the investigation of lateral neck masses. This tool has great potential in reducing treatment delay in the management of head and neck cancer.

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“…Additionally, there are other benefits for patients related to SUS, such as decreased preoperative imaging studies, reduced number of medical appointments, and superior diagnostic adequacy rates for FNA. 13,22 The SUS protocol at The Peter MacCallum Cancer Centre is standardized and is independent of pre-referral diagnosis or prereferral imaging studies. Although this study cohort sample size is small, SUS had an impact on the surgical planning of a significant proportion of these cases that highlights its utility for surgeons and patients alike.…”

Section: Discussionmentioning

confidence: 99%

“…Reliance on preconsultation US alone would have led to an inappropriate initial operation in 65.4% of this cohort. Additionally, there are other benefits for patients related to SUS, such as decreased preoperative imaging studies, reduced number of medical appointments, and superior diagnostic adequacy rates for FNA 13,22 …”

Section: Discussionmentioning

confidence: 99%

Surgeon‐performed ultrasound changes surgical management in patients with thyroid cancer

Tapia

Chia

Manji

et al. 2022

ANZ Journal of Surgery

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Background: A comprehensive neck ultrasound (US) is essential in the operative planning of patients with thyroid disease. Recent literature has shown surgeon-performed US (SUS) can be more accurate than radiology-performed US for the purpose of surgical planning. Missed findings on radiology-performed ultrasound may lead to inadequate surgical management. Methods: A retrospective cohort study of patients undergoing total thyroidectomy with lateral neck dissection for thyroid cancer, with both radiology-performed US and SUS performed by a Head and Neck surgeon. Ultrasound findings and adherence to American Thyroid Association (ATA) guidelines were compared, and changes in management based on SUS findings were identified. Results: A total of 26 patients who underwent total thyroidectomy with lateral neck dissection met the inclusion criteria. Preconsultation US investigations fulfilled criteria as recommended by the American Thyroid Association (ATA) guidelines in 57.7%% of cases. The central and lateral neck compartments were assessed in 57.7% and 84.6% of preconsultation US investigations respectively. Central and lateral metastatic neck metastases were incorrectly reported or not reported in 78.6% and 42.3% of cases. The SUS findings prompted a change in surgical management in 65.4% of cases. Conclusion: SUS changed surgical management in two thirds (65.4%) of patients. Reliance on radiology-performed ultrasound alone may result in incorrect staging. Awareness of the additional benefits of SUS is important for surgeons treating patients with thyroid disease to prevent inadequate surgery being performed.

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Surgeon-performed ultrasound in a head and neck surgical oncology clinic: saving time and improving patient care

Cited by 4 publications

References 22 publications

Remote triage incorporating symptom‐based risk stratification for suspected head and neck cancer referrals: A prospective population‐based study

Remote triage incorporating symptom‐based risk stratification for suspected head and neck cancer referrals: A prospective population‐based study

Diagnostic adequacy and accuracy of surgeon‐performed ultrasound guided fine needle aspiration in lateral neck masses

Surgeon‐performed ultrasound changes surgical management in patients with thyroid cancer

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