Lump not rump: The value of a sonographer run lump ultrasound service
Rina Hirani, Radiology, London North West Hospital Trust
Introduction:
Superficial soft tissue masses are common 3:1000 of the general adult population with the vast majority of superficial lumps being benign (99%). The value of ultrasound referral is for reassurance and the identification of potentially serious lesions requiring further assessment. The aim of the study is to show the value of an ultrasound triage by sonographers to identify cases needing further assessment
Methods:
Retrospective audit of prospectively acquired data from GP-referred lump ultrasound performed over an 8-month period by three trained and experienced sonographers was carried out. Sonographers initially had all scans reviewed by consultants, reducing to selective review after 4 weeks. Standards set locally were: >90% of reports made through a structured template identifying cases needing further assessment; images in 2 planes, with measurements and colour flow in >90%; consultant opinion in >90% of lumps >5cm, with deep infiltration, irregular margins, or suspicious intra-nodular flow.
Results:
Of the total of 113 cases, 30 patients had no lump at the time of examination. Of the 83 lumps examined, 81/83 (98%) had structured reports through templates; 78/83 (94%) had satisfactory images; 3/83 lumps were regarded as atypical and all of these were double reported by consultants. No malignancies were identified. A timely, sustainable service was provided enabling reassignment of 2-3 consultant lists per week.
Conclusion:
All standards have been met for the sonographer led lumps and bumps service. As expected, the pick-up rate of serious pathology is very low. We recommend that a sonographer run lump ultrasound service is feasible, efficient and uniform, and will allow consultant sessions to be released for complex cases.