Introduction The ultimate goal of the United Kingdom Cancer plan is to ‘offer patients a maximum one month wait from an urgent referral for suspected cancer to the beginning of treatment’.The North London Cancer Network has devised and implemented a suspected cancer referral form for General Practitioners in London for patients to be seen within two weeks of referral to secondary care. One group referred on the suspected cancer referral form is patients with a liver lesion on ultrasound(USS). However, for a service to be effective it is essential that it is not overloaded with inappropriately referred patients.
Methods The aim of the study was to assess the appropriateness and findings in patients referred to secondary care with a liver lesion on USS. A retrospective analysis of all patients referred to the gastroenterology clinic with a liver lesion on USS on the suspected cancer referral form during a 12 month period from 1st January 2011 at a District General Hospital in North London(Chasefarm Hospital) was performed. Data was collected using medical records and electronic patient results.
Results In the study period, a total of 379 patients were referred with suspected upper GI cancer. Of these 39(10.3%) were specifically referred in view of an abnormal liver lesion. The USS findings which prompted a referral was liver metastasis in 10(26%), hypoechoic lesion in 7(18%), liver mass in 6(15%), hemangioma in 4(10%), area of increased echogenicity in 3(8%), isoechoic lesion in 3(8%), cyst in 2(5%) and hyperechoic lesion, echo poor area, echo bright area, calcified foci in 1 patient each(3%). All patients were seen in the clinic within 2 weeks and 29(74%) had a CT and 7(18%) had an MRI scan.
After review of images and/or histology in the clinic/multidisciplinary meeting, 10 patients had normal scan, 9 patients had hemangioma, 8 had liver metastasis, 5 had liver cysts, 2 patients did not attend follow up, 1 patient was too frail for further imaging, 1 patient each had hepatoma, adenoma, focal nodular hyperplasia and focal fat sparing.
7/10(70%) patients with suspected metastasis on USS had confirmed metastatic disease on subsequent imaging. The 2 patients with liver cysts on USS had cysts on CT scan.
Conclusion The majority (77%) of patients with suspected cancer referred to the service did not have cancer. However, 70% of patients with suspected liver metastasis on USS had this confirmed on CT scan. Simple cysts on USS proved to be cysts on CT. We recommend that if initial USS suggests metastases it is likely to be so and would recommend CT staging and tumour markers prior to outpatient review to expedite management. USS is highly sensitive in differentiating a cyst from a solid lesion and patients with cysts on USS can be offered a routine appointment rather than being seen as a potential cancer referral.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.