Evaluating the Clinical Impact of the Direct-To-Test Neck Lump Referral Pathway. A Retrospective Review at a District General Hospital.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 41992556.
- Also identified by DOI 10.1002/hed.70283.
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Abstract
To evaluate a precision-triage, direct-to-test (DTT) neck-lump referral pathway under the National Health Service (NHS) Faster-Diagnosis-Standard (FDS). A district-general hospital in England. Prospective review of FDS referrals for "neck lump" or "unexplained thyroid lump" from November 1, 2023 to December 31, 2024. After triage, patients proceeded directly to ultrasound (DTT-USS) with further tests as needed. Minimum follow-up: 6-months. 417/440 referrals were included; 55.6% lacked clinical details. USS was normal in 110 (26.4%). Suspicious lesions requiring biopsy were found in 130, with malignancy in 12.7%, consistent with national data. Following benign/normal USS, 348 (83.5%) were removed from the cancer pathway; 71 (20%) requested review and 21 (6%) chose routine surgery. Straight-to-biopsy reduced diagnostic intervals (15 vs. 24 days, p < 0.001). The DTT-USS pathway streamlines referrals, ensures diagnostic accuracy, and improves efficiency. Standardized referral data, radiologist-led biopsy, and structured benign follow-up could further enhance sustainability.