Evaluating the Clinical Impact of the Direct‐To‐Test Neck Lump Referral Pathway. A Retrospective Review at a District General Hospital

OBJECTIVE: To evaluate a precision-triage, direct-to-test (DTT) neck-lump referral pathway under the National Health Service (NHS) Faster-Diagnosis-Standard (FDS). SETTING: A district-general hospital in England. METHODS: Prospective review of FDS referrals for "neck lump" or "unexplained thyroid lump" from November 1, 2023 to December 31, 2024. After triage, patients proceeded directly to ultrasound (DTT-USS) with further tests as needed. Minimum follow-up: 6-months. RESULTS: 417/440 referrals were included; 55.6% lacked clinical details. USS was normal in 110 (26.4%). Suspicious lesions requiring biopsy were found in 130, with malignancy in 12.7%, consistent with national data. Following benign/normal USS, 348 (83.5%) were removed from the cancer pathway; 71 (20%) requested review and 21 (6%) chose routine surgery. Straight-to-biopsy reduced diagnostic intervals (15 vs. 24 days, p < 0.001). CONCLUSION: The DTT-USS pathway streamlines referrals, ensures diagnostic accuracy, and improves efficiency. Standardized referral data, radiologist-led biopsy, and structured benign follow-up could further enhance sustainability.