A lean neck mass clinic model: Adding value to care.

OBJECTIVES/HYPOTHESIS: To demonstrate that ultrasound-guided fine needle aspiration (USFNA) with on-site cytopathologic analysis eliminates unnecessary diagnostic testing, return visits, and repeat procedures and optimizes quality of care.

STUDY

DESIGN

Retrospective cohort.

METHODS

Sixty-one new patients (28 female; 33 male; age range=19-85 years) were seen in our dedicated neck mass clinic over a 1-year period. All patients underwent USFNA of masses located in neck levels I-VI (n=40), parotid gland (n=20), or parapharyngeal space (n=1). Each patient underwent two USFNA passes followed by on-site cytopathologic analysis with additional passes if required for diagnosis.

RESULTS

Diagnosis was made in 93.4% (n=57) of patients, allowing for counseling and treatment planning at the first visit. To obtain a diagnosis, more than half (57.4%, n=35) of our patients required additional passes, which implies that they would have required an additional visit without on-site cytopathologic analysis. Treatment included observation in 42.6% (n=26) of patients, surgery in 32.8 % (n=20) of patients, and nonsurgical treatment (chemotherapy, radiation, other) in 24.6% (n=15) of patients. The average time from check-in to checkout including the clinic visit, biopsy, and treatment counseling was 103 minutes, and the average round trip mileage traveled per patient was 127.6 miles.

CONCLUSIONS

The adult neck mass is a commonly encountered scenario in otolaryngology. For the patient, this can be a stressful situation in which timely and accurate diagnosis is critical. A dedicated lean neck mass clinic model with USFNA and on-site cytopathologic analysis can be both an efficient part of one's practice and a valuable addition to patient care.

LEVEL OF EVIDENCE: 4.