Service Evaluation of a “Straight to Scan” Pathway for Neck Lumps Referred as Urgent Suspected Head and Neck Cancer

Sep 22, 2026

Uploaded by Sarah

Objectives: Referrals to the urgent suspected head and neck cancer pathway are rising faster than cancer incidence, creating strain for tertiary services. This study analyzes a novel “straight-to-scan” pathway for patients referred under the Urgent Suspected Cancer (USC) pathway, focusing on neck lump presentations, with the aim of assessing impact on the referral pathway. Methods: Retrospective analysis of USC neck-lump referrals between January–December 2021 included demographics, referral metrics, ultrasound timing, and recorded final diagnoses for outcome analysis. Results: 1808 referrals were screened; 563 had a neck lump as the sole symptom, with a 10% cancer conversion rate. Conclusion: Data supports ultrasound robustness and supports developing an STS pathway to streamline referrals and improve resource allocation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Objectives

Methods

Results

Conclusion

Introduction

Rationale for urgent suspected cancer pathways

Role of neck lump and ultrasound

Materials and Methods

Pathway and population characteristics

Laryngoscope Investigative Otolaryngology ORIGINAL RESEARCH OPEN ACCESS Service Evaluation of a “Straight to Scan” Pathway for Neck Lumps Referred as Urgent Suspected Head and Neck Cancer Adan Chew1,2 | Isaac Costa1 | Ishita Sen1 | Aurora Egalla Dewage2 | Abdelrahman Ibrahim1 | Christopher Metcalfe1,2 | James Philip McMorran3 | Ajith George1,2 1Royal Stoke University Hospital, Stoke-on-Trent, UK | 2School of Medicine, Keele University, Newcastle-under-Lyme, UK | 3NHS West Midlands Cancer Alliance, Birmingham, UK Correspondence: Ajith George ([a.george@keele.ac.uk](a.george@keele.ac.uk)) Received: 16 September 2025 | Revised: 1 December 2025 | Accepted: 28 January 2026 Keywords: head and neck cancer | pathway | service evaluation | ultrasound ABSTRACT Objectives: The number of referrals to the urgent suspected head and neck cancer pathway is increasing exponentially with the relatively slower increase in cancer incidence. Tertiary services may find it challenging to cope with this increasing demand. We have therefore analyzed data from a novel “straight-to-scan” pathway for patients referred under the Urgent Suspected Cancer (USC) pathway in our unit. This study aims to assess the impact on the referral pathway. Methods: Data pertaining to all USC referrals for patients with a neck lump to our regional tertiary head and neck cancer unit, between January and December 2021, were collected retrospectively. All patients referred with a neck lump had a neck ultrasound prior to review. Demographic data, referral metrics, and clinical information including final diagnosis were recorded and later used for analysis of the clinical course and patient outcomes. Results: 1808 USC referrals were screened, of which a total of 563 referrals were for patients referred with a neck lump as the only presenting symptom. The cancer conversion rate was 10%(57 cancers) . Two received a diagnosis following a subsequent referral after the initial ultrasound scan was graded as indeterminate. 56% of cancers were primary head and neck cancers, while 33% of cancers were hematological. Conclusion: Our data showcases the robustness of ultrasound in diagnosing neck lumps. This highlights the potential for the development of a straight-to-scan (STS) pathway which can further streamline the referral process and ensure effective resource allocation and workforce planning. Level of Evidence: N/A. 1 | Introduction The number of referrals to the urgent suspected head and neck cancer pathway is increasing exponentially and out of proportion with the relatively slower increase in cancer diagnoses [1, 2] . Coupled with workforce pressures across the National Health Service (NHS), these pathways are under unprecedented pressure and unsustainable strain as a result [1] . Efficient diagnostics, radical restructuring of pathways and efficient triage have therefore been emerging issues in this field [2] . A neck lump remains the strongest symptomatic predictor for head and neck cancer, particularly in the context of the rising incidence of Human Papillomavirus (HPV)-positive oropharyngeal squamous cell carcinomas (SCC) [3, 4] . As such, this is an essential inclusion criterion for referral on the urgent suspected This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2026 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society. Laryngoscope Investigative Otolaryngology, 2026; 11:e70352 1 of 8 [https://doi.org/10.1002/lio2.70352](https://doi.org/10.1002/lio2.70352) head and neck cancer pathway form [5] . There are numerous differentials for a perceived palpable lump in the neck ranging from normal anatomical structures to path

FAQs

What problem does the study address regarding urgent suspected head and neck cancer referrals?

Referral numbers for the urgent suspected head and neck cancer pathway are increasing exponentially and outpacing the growth in cancer incidence, creating pressure on tertiary services and challenging capacity to manage demand.

How were patients selected and what data was collected in this retrospective evaluation?

All USC referrals for patients with a neck lump to a regional tertiary head and neck unit between January and December 2021 were collected retrospectively. Patients received a neck ultrasound prior to review, and demographic data, referral metrics, and clinical information including final diagnosis were recorded for analysis.

What were the main outcomes related to cancer conversion and the ultrasound-based pathway?

Among 1808 USC referrals screened, 563 involved a neck lump as the only presenting symptom, with a 10% cancer conversion rate. The findings indicate the robustness of ultrasound for diagnosing neck lumps and support the potential development of a straight-to-scan pathway to streamline referrals and support resource planning.

Sep 22, 2026

Uploaded by Sarah