Service Evaluation of a "Straight to Scan" Pathway for Neck Lumps Referred as Urgent Suspected Head and Neck Cancer

The number of referrals to the urgent suspected head and neck cancer pathway is increasing exponentially with the relatively slower increase in cancer incidence. Tertiary services may find it challenging to cope with this increasing demand. We have therefore analyzed data from a novel "straight-to-scan" pathway for patients referred under the Urgent Suspected Cancer (USC) pathway in our unit. This study aims to assess the impact on the referral pathway.

Data pertaining to all USC referrals for patients with a neck lump to our regional tertiary head and neck cancer unit, between January and December 2021, were collected retrospectively. All patients referred with a neck lump had a neck ultrasound prior to review. Demographic data, referral metrics, and clinical information including final diagnosis were recorded and later used for analysis of the clinical course and patient outcomes.

1808 USC referrals were screened, of which a total of 563 referrals were for patients referred with a neck lump as the only presenting symptom. The cancer conversion rate was 10% (57 cancers). Two received a diagnosis following a subsequent referral after the initial ultrasound scan was graded as indeterminate. 56% of cancers were primary head and neck cancers, while 33% of cancers were hematological.

Our data showcases the robustness of ultrasound in diagnosing neck lumps. This highlights the potential for the development of a straight-to-scan (STS) pathway which can further streamline the referral process and ensure effective resource allocation and workforce planning.

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