Changes in diagnosis and treatment of breast pathology at a specialized breast clinic
Kaufman, Z.; Shapira, M.; Dinbar, A.
Harefuah 124(8): 464-8 528 527
1993
ISSN/ISBN: 0017-7768 PMID: 8335269 Document Number: 412278
The following results highlight the changes that occur when breast pathology is diagnosed and treated at a centralized breast clinic. 2 periods of 1 year each were compared. During the first year breast problems were treated in a general surgical clinic. During the second year all breast problems were diagnosed and treated in a specialized breast clinic, in which a surgeon, radiologist, pathologist and oncologist participated as a team. During the second year 81 patients were operated for breast cancer compared to 56 in the first year and to a mean of 41 in previous years. The rate of lumpectomies in the second year was 60% compared to 45% in the first. A similar number of patients with palpable findings presented in both years and there were 295 fine needle aspirations in the first year vs 290 in the second. Fewer biopsies were done for benign palpable lesions in the second year (28 vs 79) due to better interpretation of benign cytological and mammographic findings. Since diagnosis of the tumor prior to surgery was more accurate in the second year, a more specific consultation with the patient was possible. Treatment options were discussed in greater detail and the patient could therefore participate in the treatment process. The number of fine needle localization biopsies (FNLB) done during the second period was 46, compared to 15 in the first period. Good collaboration between surgeon and radiologist explains the increase in the rates of malignancies found in FNLB in the second period (50% vs 33%). The FNLBs were done in the second period by a more experienced group of specialists, and therefore the volumes excised were smaller and the pathological diagnoses more accurate. Centralized cases of breast pathology nationally into a number of specialized breast clinics will promote improved diagnosis of breast problems. It will also lead to a higher quality database and to better clinical research.