Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-24T04:31:20.175Z Has data issue: false hasContentIssue false
  • English
  • Français

Neck lump clinics: is on-site assessment of fine needle aspirate diagnostic adequacy cost-effective?

Published online by Cambridge University Press:  17 October 2013

C Burgess ,
L Dias ,
E Maughan  and
R Moorthy
C Burgess*
Affiliation:
ENT Department, Wexham Park Hospital, UK
L Dias
Affiliation:
ENT Department, Wexham Park Hospital, UK
E Maughan
Affiliation:
ENT Department, Wexham Park Hospital, UK
R Moorthy
Affiliation:
ENT Department, Wexham Park Hospital, UK
*
Address for correspondence: Mr C Burgess, ENT Department, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK Fax: 01865 231200 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To establish the diagnostic adequacy of ultrasound-guided fine needle aspiration cytology samples at the East Berkshire neck lump clinic, and to perform a cost-benefit analysis related to the hypothetical addition of an on-site cytology technician (required to review fine needle aspiration specimen adequacy).

Method:

The adequacy of all ultrasound-guided fine needle aspiration procedures was reviewed from 1 January to 30 June 2011. These results were used in the cost-benefit analysis related to on-site cytology assessment.

Results:

Of the 307 ultrasound-guided fine needle aspiration cytology procedures performed over 6 months, 67 (22 per cent) were reported to be non-diagnostic. Operator experience was found to correlate significantly with diagnostic adequacy (p < 0.001). Only 5 per cent of all fine needle aspirations were initially non-diagnostic but diagnostic on repeat sampling. This suggests that the financial and time costs of on-site fine needle aspirate adequacy assessment would outweigh any benefit.

Conclusion:

In this series, the experience of individuals performing fine needle aspirations was the most important factor related to adequacy.

Keywords

NeckBiopsy, Fine-NeedleUltrasonographyCost-Benefit Analysis
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 11 , November 2013 , pp. 1122 - 1126
Copyright
Copyright © JLO (1984) Limited 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented as a poster at the British Academic Conference of Otolaryngologists, 6 July 2012, Glasgow, Scotland, UK.

References

1Vowles, RH, Ghiacy, S, Jefferis, AF. A clinic for the rapid processing of patients with neck masses. J Laryngol Otol 1998;112:1061–4CrossRefGoogle ScholarPubMed
2National Institute for Clinical Excellence. Guidance on Cancer Services: Improving Outcomes in Head and Neck Cancers. London: NICE, 2004Google Scholar
3Steinkamp, HJ, Cornehl, M, Hosten, N, Pegios, W, Vogl, T, Felix, R. Cervical lymphadenopathy: ratio of long- to short-axis diameter as a predictor of malignancy. Br J Radiol 1995;68:266–70CrossRefGoogle Scholar
4Kruyt, RH, van Putten, WL, Levendag, PC, de Boer, MF, Oudkerk, M. Biopsy of nonpalpable cervical lymph nodes: selection criteria for ultrasound-guided biopsy in patients with head and neck squamous cell carcinoma. Ultrasound Med Biol 1996;22:413–9CrossRefGoogle ScholarPubMed
5Demharter, J, Muller, P, Wagner, T, Schlimok, G, Haude, K, Bohndorf, K. Percutaneous core-needle biopsy of enlarged lymph nodes in the diagnosis and subclassification of malignant lymphomas. Eur Radiol 2001;11:276–83CrossRefGoogle ScholarPubMed
6Vandervelde, C, Kamani, T, Varghese, A, Ramesar, K, Grace, R, Howlett, DC. A study to evaluate the efficacy of image-guided core biopsy in the diagnosis and management of lymphoma–results in 103 biopsies. Eur J Radiol 2008;66:107–11CrossRefGoogle ScholarPubMed
7Payment by Results 2010–2011 National Tariff Information. In: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_113900.xls [25 March 2012]Google Scholar
8Ganguly, A, Giles, TE, Smith, PA, White, FE, Nixon, PP. The benefits of on-site cytology with ultrasound-guided fine needle aspiration in a one-stop neck lump clinic. Ann R Coll Surg Engl 2010;92:660–4Google Scholar
9O'Malley, ME, Weir, MM, Hahn, PF, Misdraji, J, Wood, BJ, Mueller, PR. US-guided fine-needle aspiration biopsy of thyroid nodules: adequacy of cytologic material and procedure time with and without immediate cytologic analysis. Radiology 2002;222:383–7CrossRefGoogle ScholarPubMed
10Eedes, CR, Wang, HH. Cost-effectiveness of immediate specimen adequacy assessment of thyroid fine-needle aspirations. Am J Clin Pathol 2004;121:64–9CrossRefGoogle ScholarPubMed
11Howlett, DC, Harper, B, Quante, M, Berresford, A, Morley, M, Grant, J et al. Diagnostic adequacy and accuracy of fine needle aspiration cytology in neck lump assessment: results from a regional cancer network over a one year period. J Laryngol Otol 2007;121:571–9CrossRefGoogle ScholarPubMed
12Carr, S, Visvanathan, V, Hossain, T, Uppal, S, Chengot, P, Woodhead, CJ. How good are we at fine needle aspiration cytology? J Laryngol Otol 2010;124:765–6CrossRefGoogle ScholarPubMed
13Ghofrani, M, Beckman, D, Rimm, DL. The value of onsite adequacy assessment of thyroid fine-needle aspirations is a function of operator experience. Cancer 2006;108:110–3CrossRefGoogle ScholarPubMed