ROSE sampling began at the Trust in 2010, starting with endoscopic ultrasound (EUS) and advanced, specialist ultrasound techniques used to sample benign and cancerous lesions, in and around the lungs and pancreas.
The process involves a medical scientist being at a patient’s procedure and immediately assessing tissue samples. This ensures they are good enough for a detailed diagnosis to be made and, where needed, planning for appropriate treatment. With everything taking place during one procedure there is minimal risk to patients and no need for a general anaesthetic. The scope of sampling has now expanded to include, liver, adrenal, gastrointestinal and head and neck lesions.
The ROSE service is an example of collaborative working, provided by a group of care and service focused individuals, each bringing their specialist knowledge and expertise to the team. Miss Leonie Glinski (Senior Biomedical Scientist Cytopathology) and Dr James Garvican (Consultant Cytologist) lead in the real time assessment and preparation of the samples (ROSE). Dr Dush Shetty (Consultant Radiologist) leads in obtaining pancreatic, gastrointestinal, oesophageal and adrenal samples, Dr Steve Isles (Consultant respiratory physician) leads in lung sampling and Mr Venkat Reddy (Consultant ENT Surgeon) and Dr Ben Rock (Consultant Radiologist) have been enthusiastic in bringing recent expansion of the service to the head and neck department. In total, up to 30 people across radiology, endoscopy, clinical medical teams and laboratory staff are each involved in delivering the service.
Leonie Glinski stated how this invaluable service helps to reduce the need for repeat procedures and delays to treatment.
“Without ROSE, local and national data suggest that 30-40% of patients will need another, potentially more high risk procedure to get enough material to decide on the best treatment,” explained Leonie. “At RCHT, 92% of patients have enough material taken first time, enabling faster treatment with highly advanced, specific therapies and a better patient experience.”
At Royal Cornwall Hospital, over 150 EUS procedures and 90 EBUS procedures are performed every year with more than 90% success in getting suitable tissue samples for pancreatic cancer and more than 95% of new lung cancers. This exceeds the published performance of some nationally recognised “centres of excellence”.
The head and neck service has also recognised the benefits of ROSE for its fine needle aspiration clinics and, as of January this year, has streamlined all of its patients to been seen in the same clinic. ROSE support for this clinic will substantially increase effectiveness and prevent almost half of patients having to return to the hospital for repeat or more complex and invasive diagnostic procedures.
The recognition of the success of the service, and the far reaching interest it is attracting, has led to a publication about the technique, which is due for release later this year. The service is an example of collaborative working and clinical effectiveness that can be adopted in hospitals across the UK. The expansion of the service and continuing increase in activity has required additional scientists and clinical staff to be trained to provide a robust and comprehensive service. With the recent head and neck expansion, the service will benefit over 500 patients this year, with a cost saving to the trust in the region of £120,000 – £170,000.
ROSE is now seen as an essential service within RCHT, helping to reduce demand on busy appointment slots for investigation by reducing the need for a second procedure. Staff are in full support of this innovative new way of treating patients and the team has already received an array of comments, such as
“The ROSE service provided to the lung cancer team is of paramount importance, it has enable fast and accurate diagnosis of lung cancer using endobronchial ultrasound and continues to help in other cancer sites,”
“This will reduce the workload in pathology, radiology and head and neck, reducing the re-ultrasound rates for non-diagnostic fine needle aspiration. Most importantly it will also improve patient experience, reduce delays on the cancer pathway and lead to earlier diagnosis to treatment times.”