Reducing Diagnostic Delays in Head and Neck Cancer Through Surgeon-Performed Ultrasound-Guided Fine-Needle Aspiration...

There is increasing interest among ear, nose, and throat (ENT) surgeons in performing ultrasound and ultrasound-guided fine-needle aspiration biopsy (US-FNAB). Surgeon-performed ultrasound has the potential to streamline the diagnostic pathway and reduce waiting times for patients evaluated for suspected head and neck cancer. However, concerns have been raised about diagnostic accuracy when surgeons, rather than radiologists, perform US-FNAB. This study aimed to assess the diagnostic quality and time to diagnosis of surgeon-performed US-FNAB with same-day cytology for all patients referred to an academic head and neck cancer outpatient clinic.

This retrospective study reviewed patients' records from a fast-track head and neck cancer outpatient clinic. All patients underwent surgeon-performed US-FNAB with same-day final cytological evaluation by a dedicated cytopathologist. Data included demographics, biopsy site, cytology and histology results, and time from referral to a diagnostic plan. The primary outcome was the inadequacy rate of US-FNAB from cytology reports, while the secondary outcomes included the time to diagnostic plan and diagnostic accuracy. The time to the diagnostic plan was defined as the time from referral to the establishment of a final diagnostic plan. Diagnostic accuracy was assessed using US-FNAB results and final histology diagnoses when available.

A total of 155 US-FNAB samples from 117 patients were analyzed. The overall inadequacy rate was 11%, with the highest rate observed in thyroid lesions (five of 23; 21.7%). No significant difference was found between residents (5.6%) and consultants (15.3%) (p=0.054). Same-day cytology results were available for 114 (97.4%) patients. A diagnostic plan was established at the initial visit in 71 (60.7%) cases, while the remaining patients had a median time to diagnostic plan of 11.5 days (IQR 8-16). The overall median time from referral to diagnostic plan was six days (IQR 4-16). Histopathological correlation was available for 62 (53%) patients. The risk of malignancy was 0% for benign, 45.5% for undetermined, 29.4% for suspicious for malignancy, and 85.2% for malignant cytology.

Surgeon-performed US-FNABs with same-day cytology achieved high adequacy rates, allowing most patients to receive a diagnostic plan during their initial visit. Residents performed similarly to consultants, supporting the feasibility of integrating US-FNAB into routine practice across different experience levels.