August 9

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Onsite clinic shaves FNA biopsy turnaround time to a single day

Published on Wednesday, August 9, 2017

By: Cynthia Wall

NOTE: This article originally appeared in the August 2017 issue of CONSULT, UMMC's monthly electronic newsletter. To have CONSULT, and more stories like this, delivered directly to your inbox, click here to subscribe.

Finding a lump or bump that doesn’t go away creates enough worry without extending it by days or weeks to get a biopsy. Now, University of Mississippi Medical Center doctors can schedule a fine needle aspiration – FNA – for the same day they see a patient.

The UMMC Department of Pathology is hoping to shorten or eliminate the wait for a biopsy and results with the addition of an onsite FNA clinic.

The doctors who envisioned and operate the same-day clinic said pathology staff knows delivering biopsy results to patients swiftly can eliminate weeks of worry and enhance therapy planning.

Dr. Dianne Grunes, left, and Dr. Israh Akhtar
Dr. Dianne Grunes, left, and Dr. Israh Akhtar

Patients like the same-day access, said Dr. Christopher Lee, an associate professor of otolaryngology who has referred several to the clinic.

“A lot of our patients drive two to three hours to get here,” he said. “Trying to reschedule something on a different day is very difficult for them. We’re always trying to think of ways to limit how many times they have to come back.”

The concept is simple: Someone goes to his or her doctor. The doctor or nurse practitioner finds a lump or bump – what they call a palpable mass – that needs to be biopsied. Instead of making an appointment for several days or even a couple of weeks later, the doctor or nurse can call the FNA Clinic, send the patient to the clinic and sometimes get preliminary results that day.

The clinic is codirected by Dr. Israh Akhtar, a professor of pathology, and Dr. Dianne Grunes, an assistant professor of pathology. They said one key is selecting patients who will benefit the most: It’s not for everyone.

“This is only for superficial palpable masses,” Grunes said. “You can put it between your fingers and isolate it.”

The Department of Pathology, working with the Department of Dermatology, offers the service in Dermatology Suite K at the University Physicians Pavilion.

Lee said the clinic is a great addition.

“We can get a preliminary read first day, even when we may not get full diagnosis for a few days.”

The biopsy is minimally invasive: A very fine, hollow-core needle is used to take single cells from a lesion. Pathologists review the cells under the microscope to ensure they have enough tissue before the patient leaves. The pathologists then can call the referring physician with a preliminary interpretation.

“We keep the standard stains here,” Grunes said. If the result is benign, the referring physician may ask the pathologists to relay that to the patient immediately, she said. A final report may take a few more days to complete.

Sometimes patients know it is cancer.

“Then we let people know we have enough cells and what we’re going to do next,” she said. Actions may include tests that take longer than a day to complete.

“We always consult the referring clinician first,” Grunes said. “It’s important to be part of a clinical team.”

Pathologists worked with Department of Otolaryngology physicians as a pilot project and now are expanding the service to other UMMC medical services. Since the pathologists are on call in the hospital to analyze specimens removed during surgery and to provide immediate assessment for some biopsies taken from hospitalized patients under anesthesia, it is not always practical for them to travel to outlying clinics.

Grunes said the intent is to make it easy and quicker for patients. This will be especially important as more UMMC clinics open in off-campus sites. One practice won't end: Pathologists will continue going to cancer clinics at the Jackson Medical Mall Thad Cochran Center and to the Lakeland Medical Building - especially for patients who have limited transportation.

“They’ve been over here (JMM),” said Dr. Lana Jackson, an associate professor of otolaryngology and communicative sciences and a surgeon on the UMMC Cancer Institute’s Head and Neck Care Team. “Our patients love it. They don’t have to make a second trip.”

Partnering with dermatology allows the pathology department to start the clinic and build volume. Gunessaid she hopes one day the pathologists will have their own space and the same-day biopsies will be an accepted and expected part of UMMC services.