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Rethinking the ‘one-stop’ neck lump clinic: a novel pathway beyond coronavirus disease 2019

Published online by Cambridge University Press:  23 February 2023

A Hariri Open the ORCID record for A Hariri [Opens in a new window] ,
S Jawad ,
S Otero ,
M Lechner ,
S Morley ,
T Beale ,
J Hughes Open the ORCID record for J Hughes [Opens in a new window] ,
P Stimpson ,
R Dwivedi  and
F Vaz
A Hariri*
Affiliation:
Head and Neck Centre, University College London Hospitals NHS Trust, London, England, UK
S Jawad
Affiliation:
Department of Imaging, Royal National ENT and Eastman Dental Hospitals, University College London Hospital NHS Trust, London, England, UK
S Otero
Affiliation:
Department of Imaging, Royal National ENT and Eastman Dental Hospitals, University College London Hospital NHS Trust, London, England, UK
M Lechner
Affiliation:
Head and Neck Centre, University College London Hospitals NHS Trust, London, England, UK
S Morley
Affiliation:
Department of Imaging, Royal National ENT and Eastman Dental Hospitals, University College London Hospital NHS Trust, London, England, UK
T Beale
Affiliation:
Department of Imaging, Royal National ENT and Eastman Dental Hospitals, University College London Hospital NHS Trust, London, England, UK
J Hughes
Affiliation:
Head and Neck Centre, University College London Hospitals NHS Trust, London, England, UK
P Stimpson
Affiliation:
Head and Neck Centre, University College London Hospitals NHS Trust, London, England, UK
R Dwivedi
Affiliation:
Head and Neck Centre, University College London Hospitals NHS Trust, London, England, UK
F Vaz
Affiliation:
Head and Neck Centre, University College London Hospitals NHS Trust, London, England, UK Canterbury Christchurch University, Canterbury, England, UK
*
Author for correspondence: Mr Ahmad Hariri, Head and Neck Centre, University College London Hospitals NHS Trust, 235 Euston Rd, London NW1 2BU, UK E-mail: ahmad.hariri@nhs.net
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Abstract

Objectives

UK guidelines advocate ‘one-stop’ neck lump assessment for cancer referrals. This paper reports the pilot of a novel pre-clinic ultrasound pathway, presents outcomes, and discusses strengths and limitations in the context of the coronavirus disease 2019 pandemic.

Methods

Two-week-wait cancer referral patients with a neck lump were allocated a pre-clinic ultrasound scan followed by a clinic appointment. Demographic, patient journey and outcome data were collected and analysed.

Results

Ninety-nine patients underwent ultrasound assessment with or without biopsy on average 8 days following referral. Patients were followed up on average 14.1 days (range, 2–26 days) after initial referral. At the first clinic appointment, 45 patients were discharged, 10 were scheduled for surgery, 12 were diagnosed with cancer, 6 were referred to another specialty and cancer was excluded in 19 patients. Retrospectively, four ultrasounds were performed unnecessarily.

Conclusion

Pre-clinic ultrasound scanning is an alternative to the one-stop neck lump pathway. This study demonstrates fewer clinic visits, faster diagnosis and a low proportion of unnecessary scans, whilst minimising face-to-face consultations and aerosol-generating procedures.

Keywords

Squamous Cell Carcinoma of Head and NeckDelivery Of Health CareUltrasonographyCOVID-19
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 6 , June 2023 , pp. 704 - 708
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr A Hariri takes responsibility for the integrity of the content of the paper

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