Can a sonographer be trained to be proficient in head & neck ultrasound with fine-needle aspiration cytology?

Roma Dave, Portsmouth Hospitals University NHS Trust


Ultrasound-guided fine-needle aspiration cytology (FNAC) is a commonly performed procedure and often the first line of diagnostic testing for patients presenting with a head and neck swelling. This technique yields a high accuracy rate and is recommend by NICE guidance. The head and neck ultrasound waiting list, consequently, has always highlighted capacity issues and this became more pronounced during Covid-19 due to the temporary cancellation of clinics. The aim of training a sonographer was to reduce the ultrasound waiting list and allow the radiologists more time in other areas, such as reporting cross-sectional imaging. The aim of this study was to document how training was undertaken, and whether FNAC success rates were comparable to those performed by radiologists.


In-house training was undertaken over a 12-month period by three consultants in an acute and outpatient setting. A retrospect audit was performed of FNAC outcomes, comparing sonographer and radiologist non-diagnostic rates, over an 18-month period. Statistics of the ultrasound waiting list were also analysed over this period.


250 FNAs performed by a sonographer were analysed. Results showed a 71% conclusive rate. This was compared to a previous 4-year audit, undertaken by radiologists within the department. The comparison study analysed 1,222 FNAC samples and demonstrated a non-diagnostic sample of 27.2%. This was compared with the RCR live audit, which expects a 70% diagnostic rate for FNAC samples of the thyroid. This study demonstrated comparable FNAC results between a sonographer and consultant radiologist. Statistics also showed a decrease in the ultrasound waiting list, from 310 patients to 114 patients in the past 18 months.


It is possible to train a sonographer to become proficient in head and neck scanning with FNAC and for cytology rates to be comparable to that of a radiologist. The study showed a positive impact on the ultrasound waiting list.

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