Lean Neck Mass Clinic Model Reduces Time to Diagnosis

by Amy Hamaker •

What are the benefits of ultrasound-guided fine needle aspiration (USFNA) with on-site cytopathologic analysis for neck masses?

Background: Early diagnosis and management is critical for successful treatment in patients who present with neck masses as a sequela of malignancy. Utilizing lean management principles, the authors demonstrated that in-office USFNA with immediate on-site cytopathologic analysis at their lean neck mass clinic model optimized care quality and eliminated unnecessary diagnostic testing, return visits, and repeat procedures.

Study design: Retrospective cohort of 61 new patients over a one-year period.

Setting: Lean Neck Mass Clinic, Department of Otolaryngology–Head and Neck Surgery and Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor.

Synopsis: One staff otolaryngologist with expertise in head and neck oncology as well as American College of Surgeons thyroid and parathyroid ultrasound certification performed all office-based USFNA procedures. The specimens were then handed off to the on-site cytopathologist or cytotechnician for immediate processing and reviewed in person or via telecommunication with an off-site cytopathologist. Diagnosis was made in 93.4% of patients; to obtain a diagnosis, more than half of patients required additional passes. On-site core needle biopsy was performed in 8.7% of patients if lymphoma was highest on the differential diagnosis or if additional tissue was required for diagnosis/treatment planning.

All patients with a parotid mass received a diagnosis at the first visit. Of the four patients who required additional workup, three had neck masses and one had a parapharyngeal space mass. Of the 19 patients who had surgical therapy, 16 had their diagnoses confirmed on final pathology. Although USFNA has a higher sensitivity and specificity when compared to conventional FNA with palpation alone, it should be remembered that it historically fails to provide an adequate sample or has indeterminate cytologic findings in 10% to 20% of cases.

Bottom line: By reducing time to diagnosis and the need for return visits, a dedicated lean neck mass clinic model with USFNA and on-site cytopathologic analysis decreases wait times and allows surgeons to see more new patients.

Citation: Tillman BN, Glazer TA, Ray A, Brenner C, Spector ME. A lean neck mass clinic model: adding value to care. Laryngoscope. 2015;125:2509-2513.