Nurse led clinics may actually cost more

EDITOR—Garvican et al conclude that since the results of the fine needle aspiration obtained by clinical nurse specialists in their breast clinic were better than those obtained by other clinicians the nurses' clinical expertise compared favourably with that of other clinicians.1 In a recent four month survey of fine needle aspiration cytology in our unit, 86 (20%) of 432 aspirates were classed as inadequate (C1). This is significantly lower than the rate of 276 (33.5%) of 825 samples (P<0.0001) classed as inadequate in Garvican et al's paper. Two thirds of the aspirations of palpable lesions in Edinburgh were performed by consultants; their rate of inadequate samples was 38/233 (16%). This is significantly lower than the 114 (32%) of 362 samples taken by the nurses that were classed as inadequate (P<0.0001). The nurse specialists performed 362 (44%) of 825 aspirations in their clinic; in Edinburgh non-consultant clinicians performed 35 (28%) of 124 (P=0.012). These results confirm that the experience of the clinician performing an aspiration is an important factor in the success of the technique.2

In the breast clinic the ratio of benign samples to malignant samples was 5.1:1, while in Edinburgh it was significantly lower at 1.2:1 (P<0.0001). In Edinburgh all patients are seen by experienced consultant breast surgeons or senior doctors, and immediate access to mammography and ultrasonography is available during the clinic. This may explain the apparently better selection of patients for aspiration cytology, which is the most painful test performed in breast clinics.3

We recently introduced a “one stop” clinic in …