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Neo-adjuvant chemotherapy may be considered for suspected testicular malignancy if widespread life-threatening metastases are identified on computed tomography (CT) imaging. Staging preoperatively enables this and may prevent delays in ongoing oncological care. This project aimed to increase the proportion of staging scans performed preoperatively in the University Hospitals of Leicester NHS trust. Method All referrals between 01/01/2016 and 31/12/2018 to the urology multidisciplinary team for suspected testicular cancer were reviewed. Exclusion criteria were applied prior to collecting treatment pathway data for each patient. Based on initial audit findings, clinicians were advised to request staging CT scans at the first urology clinic appointment. Re-audit was between 01/01/2019 and 31/12/2019. Results Initial audit included 95 patients and re-audit included 23 patients. The proportion of preoperative scans increased from 28.4% to 82.6% following intervention. Median time from first ultrasound to CT was reduced from 44 days to 17 days without affecting median time to orchidectomy (27 to 23 days) or oncology appointment (61 days). Conclusions Requesting a staging CT scan as part of the first clinic assessment improved the proportion of preoperative scans without affecting time to surgery or oncology appointment.

415 Improving Preoperative Computed Tomography Staging for Men with Suspected Testicular Cancer