Ultrasound guided procedures in the head and neck: a clinician centered model

Background: US guided sampling is a validated diagnostic approach for non-thyroid deep head and neck masses. Aim: To describe the setting of a clinician-driven Lump Clinic and analyze a monoinstitutional 7-year database of 849 patients undergoing US-guided sampling. Methods: FNA with Rapid OnSite Evalutation (ROSE) was the first diagnostic step. In the last years in selected cases, upon ROSE and discussion between clinician and histopathologist, a core biopsy was performed, usually in the same access. If cytology is non-diagnostic, and core biopsy have not been obtained, all available clinical and diagnostic data were re-examined by surgeons and cytopathologists to establish a multiparametric diagnosis (MD). Results: Cytology and MD showed a sensitivity of 91.8% and 95.3% respectively and a specificity of 95.7% in diagnosing malignancy. Complication rate of US guided sampling was 0,12% (considering the number of patients: 1/849), without any serious adverse event. Conclusions and significance: Present data confirm the great safety and utility of US guided procedures in the management of head and neck non-thryoid deep masses, while demonstrating the added value of a lump clinic built on the close cooperation between the head and neck surgeon and the histopathologists.