Maintaining Neck Biopsy Diagnostic Yield and Time-to-Biopsy Through Volume Increase: A Quality Improvement Initiative.

Background: Percutaneous ultrasound-guided core needle biopsies (CNB) and fine needle aspirations (FNA) provide high yield and minimal risk for neck pathology diagnosis. Organizational shifts led to the planned closing of a long-standing pathology FNA clinic and a potential doubling in biopsy volume for our neuroradiology neck biopsy service.

Purpose: We formulated a quality improvement (QI) initiative with three goals for our service: (1) maintain or decrease mean days to biopsy, (2) maintain or decrease variation in days to biopsy, and (3) maintain diagnostic yield.

Methods: We added physician assistants to the biopsy team and opened a community hospital biopsy clinic. Weekly neuroradiology neck CNB and FNA were tracked from September 4, 2023, to June 23, 2024.

Results: As anticipated, biopsy volume nearly doubled (6.1 ± 2.4 to 12.1 ± 1.2 per week between the first and last 8 weeks, p = .006). Statistical process control methods showed special cause shorter mean times-to-biopsy (8.6 days from 9.6 days) and special cause reduced week-to-week variation (0.8 days from 2.0 days) attributable to our process changes without special cause change in diagnostic rate (90.1% across the project period).

Conclusions: These results highlight the successful application of QI methodology to modify and monitor volume-driven adaptations in a medical procedure clinic.