People with head and neck lumps that could signify cancer will be spared weeks of avoidable waiting and worrying before getting a diagnosis.
Some of these patients require a form of biopsy known as an ultrasound-guided fine needle aspiration (FNA).
This uses ultrasound pictures to guide a needle to take a small sample to be analysed by a cytologist, who evaluates cell samples and can accurately detect cancer as opposed to benign conditions.
Sometimes, though, the sample is not adequate for the cytologist to make an assessment. So the patient has to be brought back for the biopsy to be done again – and if necessary, again after that.
All this adds to the time taken before a diagnosis can be confirmed, when time really can be of the essence.
Main photo above. Head and neck lump team: Dr Shaheena Sadiq, fourth left with colleagues (l-r): health care support worker Julie Williams, radiographic assistant Cheryl Bozilovic, RDC nurse Courtney Jones, sonographer Nicola Ardey-Jones and clinical nurse specialist Susan Blackmore.
Ultrasound-guided FNAs are currently carried out within radiology across the health board, as well as the new neck lump clinic at the Rapid Diagnosis Centre (RDC) at Neath Port Talbot Hospital.
Now a new pathway is being trialled in radiology, which will allow that first sample to be checked immediately before the patient leaves the hospital.
It’s known as Rapid On-Site Evaluation, or ROSE, and means that if another biopsy is necessary it can be done in the same appointment.
The trial has been made possible after consultant head and neck radiologist Dr Shaheena Sadiq was awarded funding by Wales-based not for profit organisation Moondance Cancer Initiative.
Head and neck lumps can signify various neck cancers, as well cancers from other areas such as breast, lung and melanoma.
Dr Sadiq said: “For some of these lumps, ultrasound-guided FNA is more suitable.
“It takes a few cells rather than a larger core of tissue – akin to the apple seeds rather than the whole core – and we send that sample to the cytology lab.
“However, we do not know if the sample is adequate for assessment. That is all we want to know at that stage. Is it adequate for the cytologist to view and give a diagnosis?
“We don't want a diagnosis there and then, but we need to know if we have enough of a sample, because we are unable to assess that.
“But 10 days, two weeks later, we might find out the sample is inadequate, so we have to get the patient back for the same procedure.
“And the patient may need to go through the procedure again, or change the type of biopsy sample.
“We can lose a month, sometimes six weeks in this extended pathway before we actually get a diagnosis.
“Only after that information can we do the scans, and the patient can be referred to the appropriate multidisciplinary team and start treatment.”
Dr Sadiq undertook an audit which showed that, in 2019, adequate samples were taken around 70 per cent of the time.
However, this still left almost a third of patients who had to be recalled, facing a delay in diagnosis as a result.
Now Moondance Cancer Initiative has awarded Dr Sadiq around £20,000 to introduce ROSE in radiology and the RDC.
The funding will pay for a new microscope, the chemical stains used in the tests, and for a Band 7 biomedical scientist to attend clinics at Neath Port Talbot Hospital.
This will initially start within the RDC, then expand to other ultrasound lists across the health board.
“We can send the slides round the corner to another room with the new microscope within the radiology department while the patient is still here,” said Dr Sadiq.
“They will then give us the all-clear to send the patient home or get the patient back in the room and repeat the procedure if there is not enough material in the sample.
“Patients will benefit because it removes the anxiety of having to come back for further biopsies. We can also get the diagnosis time down to around two weeks.
“We save the clerical time that goes into organising the patient to re-attend. It also frees the appointment slot we would have used to repeat the procedure, for another potential cancer patient.”
Andrew Powell, Deputy Service Manager for cellular pathology, which includes clinical cytology, helped develop ROSE.
“The department is fully supportive of the service improvement,” said Mr Powell.
“I feel this is a fantastic development, which will of great benefit to the patients. It will avoid the need for repeat biopsies and will eventually reduce the time patients have to wait for a result.”
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