The Integrated Diagnostic Approach

What is the Integrated Diagnostic Approach?

The Integrated Diagnostic Approach is a patient care model where all diagnostic information is gathered in one place, and the data gathered relating to each patient is incorporated into a single report. At our Cytodiagnostic Center, we perform diagnostic ultrasound studies, ultrasound guided fine needle aspiration biopsies, process the specimens on site and provide preliminary diagnoses for patients. For our endocrinology patients, we can also take blood samples for metabolic testing at the same visit. In the case where additional testing is needed, such as molecular testing or flow cytometry, we can collect additional samples immediately and the patient does not need to return for a repeat biopsy. Our final report incorporates all the data collected from the ultrasound, cytopathology and additional studies so that our referring physicians can get a complete clinical picture of their patient.


How is this model put into practice?

We review previous radiologic studies and reports, if available. We take a thorough clinical history from each patient, seeking to define the whole clinical picture that each patient brings to the visit. Prior to performing the Ultrasound Guided FNA (USFNA), we perform a complete ultrasound examination, comparing the results we see on our scan to any previous outside scans. If it’s been a while since the patient had their initial study, useful information can still be obtained. We can see if the nodule has increased or decreased in size, what the qualities of the nodule is now compared to what it was previously, and features can be compared to the previous study. Performing a complete ultrasound exam allows us to get an idea of the anatomy of not only the nodule to be sampled, but also the so-called anatomic climate of the area overall. Some questions to be asked are: is there only one nodule, or are there several nodules to be sampled? Are any lymph nodes evident on the ultrasound? Are there any anatomic variations seen? What is the overall size of the gland, is it symmetric or assymetric?  These questions can and should be answered prior to performing a biopsy.

Ultrasound Machine

Why is a Pathologist uniquely qualified to perform USFNA?

A pathologist who performs USFNA has certain advantages over other specialists who perform these procedures. First, performing the ultrasound allows first-hand knowledge of the quality of the nodule that is sampled. The pathologist does not have to wonder about what the nodules looks like and if there are suspicious features evident on the ultrasound. Second, a pathologist performing the USFNA has no question as to whether or not the lesion has been sampled. The pathologist knows that the cells being evaluated are cells that came from the nodule. Third, the pathologist who performs the biopsy evaluates the specimen obtained immediately, so the specimen is always adequate, even if more samples need to be taken after evaluating the initial specimen.  Furthermore, if a specimen needs to be sent for other testing, such as molecular studies or flow cytometry, the pathologist does not need to call the patient to come back for another biopsy procedure. The patient does not have to take another day off for a follow up procedure, which is a concern for patients who work.

How does this benefit you and your patients?

You and your patients benefit from our Integrated Diagnostic Approach to USFNA because we will obtain all the information necessary for you to have a complete clinical picture of your patient from a diagnostic point of view. We will provide you with radiologic, pathologic and clinical information all in one report and you only need to send your patient to only one location for only one visit, in most cases. Your patients will enjoy the convenience of not having to go to several places for their studies, they will not need to take additional days off from work or school in order to go to several different appointments, and they will not need to return to us for additional sampling.  You will receive the reports in a timely and efficient manner, since all specimens are processed on site, there are no issues with couriers or delayed processing. Most reports are finalized within 24 hours of the patient visit.

What is the next step?

Find out for yourself how our Integrated Diagnostic Approach will benefit you and your patients. We hope that you will give us a try with your next patient!  What are you waiting for?