Lean Six Sigma Applied to Ultrasound Guided Needle Biopsy in the Head and Neck.

Objectives: (1) Confirm the positive value stream of office-based ultrasound using Lean Six Sigma; (2) demonstrate how ultrasound reduces time to diagnosis, costs, patient inconvenience and travel, exposure to ionizing radiation, intravenous contrast, and laboratory tests.

Study Design: Case series with historical controls using chart review.

Setting: Tertiary Veterans Administration Hospital (university-affiliated).

Seminomas with exclusive intertubular growth: a report of 12 clinically and grossly inconspicuous tumors.

Intertubular growth in seminoma is characterized by seminoma cells, either singly or in small clusters, between preserved seminiferous tubules. It is a common, although focal, pattern in many seminomas where it is admixed with the usual sheet-like and nested arrangements and does not pose any diagnostic problems in such cases. We describe, in contrast, the clinicopathologic features of 12 cases with exclusively intertubular growth and which were typically diagnostically problematic.