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Sep 25, 2018

ESGO State of the Art 2018 Conference

Catch it Quick: An Audit of the PMB pathway in UHNM

post menopausal bleeding

endometrial cancer

pipelle biopsy

Abstract

Abstract

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Keywords

post menopausal bleeding

endometrial cancer

pipelle biopsy

Abstract

Background This audit was undertaken to determine the effectiveness and efficiency of the University Hospital of North Midlands (UHNM) post-menopausal bleeding (PMB) pathway in diagnosing endometrial cancer. The 2 week wait (2WW) PMB clinic at UHNM provides a service to comply with NICE guidance. UHNM trust guidance advises on how to investigate and manage each case based on endometrial thickness, use of Tamoxifen, USS findings and recurrent PMB. Methods Patient data was collected from 2WW referrals to UHNM gynaecology from June 2017 to August 2017. In this 3 month period, 115 patients attended a RAC appointment. All clinic activities were recorded along with USS findings and referral for outpatient hysteroscopy (OPH). The data in this study was obtained from patient records through the intranet patient database and has been anonymised. This data was analysed to ensure effectiveness of the UHNM PMB pathway by analysing each arm of the pathway. The efficacy of the pipelle biopsy and the relationship between Tamoxifen use and endometrial cancer was also explored. Results There were 115 referrals, 7 of which were inappropriate as they had a previous hysterectomy. There were 17 pipelle biopsies were taken overall at PMB clinic; 13 diagnostic but 4 insufficient for analysis making this test on 76% accurate in detecting abnormalities. 41 of the 43 patients undergoing hysteroscopy had a pipelle at the time of hysteroscopy. Only 2 of these had insufficient sample for analysis. 5% pipelles in this cohort were insufficient. Pipelle histology sent from clinic was always reported within 7 days and was therefore always confirmed prior to hysteroscopy reinforcing the importance of the pipelle in the pathway for early diagnosis. Of the 43 patients sent for hysteroscopy – 14 patients breached the trusts 14 day target. The reasons for breach are broadly divided into patient factor n=4 (medical conditions causing delay/ patient choice) and service provision n=10 (no interpreter/ date provided outside guidelines). 5 patients were diagnosed with cancer through the PMB pathway- NICE guidance states that from GP referral to diagnosis the target is 62 days. 3 of the 5 cancer patients breached the 62 day wait; 1 due to patient choice, 1 due to delayed treatment decision, 1 due to medical co-morbidities affecting fitness for surgery. Conclusions Auditing against our PMB diagnostic pathway (as per ET measurements on TVS), we find that 13/27 women with ET5-8mm did not have pipelle in 2ww clinic and went straight to OPH. While compliant with PMB diagnostic pathway, 25/28 women with ET>=9mm went straight for OPH with EB in 2ww clinic. Clinic capacity limitations mean that currently we will not be able to achieve listing for OPH within 7 days of the initial 2ww clinic appointment and this requires new initiatives for example booking. Incidentally, histology is able to be reported within 7 days for pipelles sent from 2 ww clinic and changing the pathway to include pipelle as 1st line investigation even if ET >9mm would help waiting times and improve time to treat figures.

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© Copyright 2019 Morressier GmbH.
All rights reserved.