The impact of ultrasound in an integrated one-stop sarcoma clinic. Issue 4 (April 2020)

• Record Type: Journal Article
• Authors: Sinha, R.; Mohamed, A.M.; Karsandas, A.
• Is Part Of: Clinical radiology. Volume 75:Issue 4(2020)
• Page Start: 321.e21
• Page End: 321.e28
• Publication Date: 2020-04
• Subjects: Medical radiology -- Periodicals; Radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiology -- Periodicals; Societies, Medical -- Periodicals; Medical radiology; Radiotherapy; Electronic journals; Periodicals; 616.0757
• DOI: 10.1016/j.crad.2019.12.007
• Languages: English
• ISSNs: 0009-9260

Abstract

Abstract : AIM: To evaluate the utilisation of ultrasound within a one-stop clinic model in a regional bone and soft-tissue sarcoma centre in the UK, assess its contribution to patient management, and compare diagnostic outcomes to general musculoskeletal "lumps and bumps" clinics. MATERIALS AND METHODS: This study was a retrospective evaluation of 1, 918 referrals between October 2016 and September 2018. All ultrasound examinations and biopsies were performed by one of two musculoskeletal sarcoma radiologists. Ultrasound criteria for suspicion of malignancy were agreed. Study parameters included patient demographics, imaging modality, imaging findings, biopsy results, and time intervals. Correlation has been made between imaging findings and biopsy results. RESULTS: Five hundred and twenty-four patients (27%) underwent diagnostic ultrasound within the one-stop clinic, out of which 244 (46.5%) underwent an ultrasound-guided biopsy within the same appointment. From this cohort, 412 (78.6%) were given a likely benign diagnosis, either based on imaging alone or in combination with an ultrasound-guided biopsy and a histologically malignant diagnosis was made in the remaining 112 (21.4%). Diagnostic ultrasound within the one-stop sarcoma clinic has a positive predictive value of 86%, negative predictive value of 97%, and sensitivity of 89%. CONCLUSION: Integration of ultrasound within a one-stop sarcoma clinic provides rapid diagnostic imaging input within the outpatient setting and facilitates early effective triaging of patients into appropriate management plans. It reduces waiting times, unnecessary outpatient appointments and short-term patient anxiety. Clinical and communications skills of the sarcoma radiologist are of paramount importance to improving overall efficiency and patient experience. Highlights: Ultrasound has a negative predictive value of 97% in a one-stop sarcoma clinic. Less than 40% of referrals assessed with ultrasound required further imaging. Efficient diagnostic pathway facilitating early triaging and biopsy. True mantle of a clinical radiologist comes to light in a one-stop service.