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

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