UK first one-stop kidney cancer clinic at Addenbrooke’s in Cambridge offers biopsy, diagnosis and treatment discussion on same day

A one-stop clinic offering an ultra-fast way of diagnosing kidney cancer has been pioneered at Addenbrooke’s Hospital in a UK first.

Waiting times for patients have been cut by up to a month by offering same-day diagnosis thanks to the use of a £250,000 confocal microscope that was funded by Addenbrooke’s Charitable Trust (ACT) and the University of Cambridge.

Looking much like an office printer or scanner, the device diagnoses biopsy samples in the clinic within minutes.

Prof Grant Stewart, consultant urologist at Addenbrooke’s and professor of surgical oncology at the University of Cambridge said: “For the first time in the UK, we are using a confocal microscope in this innovative way to benefit patients. Offering same day diagnosis helps reduce anxiety, cuts down on hospital appointments and means patients can have that all-important discussion with their doctor about treatment options significantly sooner.”

The clinic involves a team of urologists, radiologists, pathologists and specialist nurses at Cambridge University Hospitals NHS Foundation Trust (CUH).

Patients with suspected kidney cancer can have a biopsy, receive a diagnosis and discuss treatment options at the one-stop clinic on the same day.

A biopsy is often needed to determine if a lump or mass on the kidney is malignant but standard pathology analysis takes time to process. Patients can be left waiting weeks for cancer to be confirmed or ruled out.

Confocal microscopes are more typically used in dermatology, but are able to provide high resolution images of tissue samples. Once a sample is stained and then scanned by the microscope, pathologists are able to make an immediate diagnosis.

Semi-retired civil servant Ken Pottle, 63, from Bury St Edmunds, visited in March after a scan for an unrelated condition showed a lump on his kidney.

After a biopsy and diagnosis of cancer, he opted for thermal ablation - a treatment that uses heat to destroy tumours.

Following his treatment in April, he was given the all-clear a couple of weeks ago and said he would not hesitate to recommend the clinic.

Mr Pottle said: “I’m a very pragmatic person, so knowing I had a treatment plan in place helped me process my cancer diagnosis. Waiting to find out if you have cancer can be incredibly worrying. When I heard about the one-stop kidney clinic, I thought ‘wow, what a fantastic idea’. The fact that I could have a biopsy, receive a diagnosis and talk through treatment options with my doctor there and then, all on the same day, made such a difference.”

The father of five and grandfather of two added: “Five months on from my treatment, I’ve now been given the all-clear. I’m back at work and enjoying life, spending time with my children and grandchildren, and getting back on my motorbike. The whole process has been brilliant.”

Research published in European Urology Oncology on 15 October shows cancer waiting times for patients at the kidney clinic were more than halved, as average waiting times were cut by a month.

Those patients on a multi-appointment pathway typically waited 55 days between first being referred and a decision being made about treatment. Patients attending the CkOSMIC (Cambridge kidney One-Stop Mass Investigation Clinic) waited just 25 days.

Results from the confocal microscope were shown to be accurate and reliable when compared with standard pathology tests. There was a 91.7 per cent match between the diagnoses made using the confocal microscope and final pathology while in the other 8.3 per cent of cases, the diagnoses was agreed but the cancer subtype was uncertain.

Out of 48 patients evaluated in the study, none of the treatment plans made on the day at the clinic needed to be changed after their formal biopsy pathology analysis was completed.

The confocal microscope is not intended to replace standard pathology tests, which provide additional details like the cancer grade. But the accuracy of the diagnoses made using it means clinicians can discuss results and treatment options much earlier.

Pathologists are also able to assess instantly if a biopsy has been successful, if there is enough tissue to make a diagnosis or if a second one is required.

In the study, four patients were identified as needing a repeat biopsy, which took place on the same day, meaning they did not have to return at a later date for another appointment.

Some 96 per cent of patients surveyed said they had enough time to ask questions and consider treatment options on the day.

And clinicians say they would like to see it used more widely, with 100 per cent of urologists and pathologists agreeing it was suitable for initial diagnosis and treatment planning.

Prof Stewart said: “For Addenbrooke’s Hospital to be able to take the lead on this as the first hospital in the UK to have this cutting-edge microscope is monumental and down to the kind donations of everyone who has supported our wonderful hospital charity, Addenbrooke’s Charitable Trust. What patients at the hospital may not realise is that, without the support of ACT and everyone who donates to our amazing charity, we simply would not have the funds to buy innovative equipment or fund vital research here at Addenbrooke’s - and that is where we really excel, by bringing ‘firsts’ to Cambridge that save lives.

“By donating to ACT, supporters look set to change the future practice of kidney cancer diagnosis with The Cambridge Kidney One Stop Mass Investigation Clinic (CKOSMIC) project– not just here, but across the UK too.

“To know that the majority of the funding from ACT in this instance comes from money left to the charity in people’s wills is incredibly humbling and as a consultant it is incredibly satisfying to be able to share with the families of these kind donors just what a difference their money has made, and will continue to make in months and years to come.”

Prof Stewart, the national lead for the Getting It Right First Time ideal pathway for kidney cancer and clinical director of the National Kidney Cancer Audit, helped develop new kidney cancer guidelines for NICE.

These recommend that more patients with suspected cancer should have a biopsy to confirm their diagnosis sooner in order to treat their disease more effectively.

He hopes the one-stop kidney clinic approach could become standard care for renal tumour biopsies and there is the potential for it be applied to other cancers in the future.

The clinic’s approach was influenced by work being done on service improvement and transformation as part of the development plans for the forthcoming Cambridge Cancer Research Hospital.

Shelley Thake, chief executive of ACT, said: "I hope everyone reading this story and who has kindly donated to Addenbrooke's Charitable Trust feels justly proud of the extraordinary impact this project is having, because this life saving project has been made possible because of them. This incredible piece of equipment, and the clinic that Grant has set up, is the perfect example of why ACT is here, to work with amazing clinicians and make possible their ideas that change and save lives.

“This project gives us a glimpse of what will be possible when the new Cambridge Cancer Research Hospital is built - brilliant clinicians and pioneering research delivering early diagnoses and personalised treatment to change the story of cancer."