Imaging-led symptomatic breast clinics: a case for direct access to radiology

The role of radiologist in the changing world of healthcare: a White Paper of the European Society of Radiology (ESR)

Radiology as a specialty has been enormously successful since its beginnings, moving over time from an adjunct to clinical decision-making to a crucial component of multidisciplinary patient care. However, this increased centrality of radiology and reliance on our services carries within it dangers, prominent among them being the danger of our being viewed as deliverers of a commodity, and the risk of our becoming overwhelmed by increasing workload, unable to interact sufficiently with patients and referrers due to pressure of work. With this White Paper, the Board of Directors of the European Society of Radiology (ESR) seeks to briefly explain the position of the radiologist in the modern healthcare environment, considering our duties and contributions as doctors, protectors, communicators, innovators, scientists and teachers. This statement is intended to serve as a summary of the breadth of our responsibilities and roles, and to assist radiologists in countering misunderstanding of who we are and what we do.

The symptomatic breast services in a university hospital: pandemic peak compared to the pre-pandemic year and future implications

Background

COVID-19 infection led to a substantial overhaul of the symptomatic breast services within the UK.

Aim

The purpose of this study was to evaluate the pattern of primary care referrals to the symptomatic one-stop clinic during the pandemic. This study also provides a snapshot of the workings of symptomatic breast services and the scope for improvements.

Methods

The data points were collected for 1 month during the peak of the pandemic (April 2020) and compared to corresponding data points for the same month in the previous year (April 2019). This was compared to the monthly data from Wales Cancer Network (WCN) data source. A hundred patients from each month over 2 years were evaluated to get a snapshot into the working of the breast clinic.

Results

A total of 516 patients were referred from primary care or General Practitioners (GPs), and were seen in the Hospital ‘one-stop breast clinic’ in April 2019. This number dropped to 330 patients during the peak of the pandemic in April 2020. Ninety percent of referrals from the GP were urgent suspected cancers or urgent referrals. This trend of referrals did not change over 2 years. There was a 5% and 7% cancer diagnosis rate in 2020 and 2019, respectively.

Conclusions

Most patients were referred from GP as ‘urgent’ or ‘urgent suspected cancer’. The cancer diagnosis rate reduced from 7 to 5% during the pandemic peak but the number of ‘worried well’ patients did not reduce. The total number of referrals reduced, which is predictive of increased demand in the future. The authors have suggested ways to meet this demand.

"One stop" clinic for upper gastrointestinal cancer-an alternative to "straight to test" referrals?

BACKGROUND

Patients suspected to have upper gastrointestinal (UGI) cancer can be referred directly for investigation; however, at times this may result to inappropriate referrals. This study explores the model of a "one-stop" clinic as an alternative to the direct referral system. The current study aims to assess the feasibility and outcomes of a one-stop UGI clinic and evaluate sensitivity and specificity of "on-the-day" diagnoses.

METHODS

A retrospective analysis of case notes of patients seen in one-stop clinic, between January 2017 and January 2019, was conducted. All General Practitioner (GP) referrals were screened by a specialist nurse.

RESULTS

After completion of the post-GP referral screening process, 252 patients (median age 68 years, IQR 58.8-77.3 years; M:F ratio 118:134) were allocated to the one-stop clinic. OGD was not required, contra-indicated or declined in 27 cases (10.7%). The records of three patients could not be found. One patient did not attend. Overall, 221 patients underwent testing and received "on-the-day" diagnoses. Sensitivity was 94% (range 87-100%), and specificity was 92% (88-96%). Ninety-six percent of patients received a diagnosis on the day.

CONCLUSIONS

The one-stop clinic was feasible and had good specificity and sensitivity. The finding of 10.7% of cases not being suitable for OGD indicates that a patient/specialist consultation is necessary to prevent misuse of endoscopy appointments. The authors recommend widespread adoption of one-stop clinics in UGI surgery.

Symptomatic breast services in the post-COVID-19 era

The COVID-19 pandemic has necessitated unprecedented changes to the functioning of hospitals across the world. This article evaluates the acute impact of COVID-19 on the provision of symptomatic breast services in the UK and explores suggestions for more sustainable functioning of services in the post-COVID-19 era.