The challenge of rapid diagnosis in oncology: Diagnostic accuracy and cost analysis of a large-scale one-stop breast clinic

Delaloge, Suzette; Bonastre, Julia; Borget, Isabelle; Garbay, Jean-Rémi; Fontenay, Rachel; Boinon, Diane; Saghatchian, Mahasti; Mathieu, Marie‐Christine; Mazouni, Chafika; Rivera, Sofía; Uzan, Catherine; André, Fabrice; Dromain, Clarisse; Boyer, Bruno; Pistilli, Barbara; Azoulay, Sandy; Rimareix, Françoise; Bayou, E.H.; Sarfati, Benjamin; Caron, Hélène; Ghouadni, Amal; Leymarie, Nicolas; Canale, Sandra; Mons, M.; Arfi-Rouche, Julia; Arnedos, Mónica; Suciu, Voïchita; Vielh, Philippe; Balleyguier, Corinne

doi:10.1016/j.ejca.2016.06.021

Cited by 37 publications

(34 citation statements)

References 22 publications

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“…The authors also recognize that reviews of past studies, which vary in patient population, diagnostic approach and statistical analysis, may not represent current best practice, which now includes sophisticated imaging and in many patients the use of ultrasound to assist with guidance of the FNAB and the use of ROSE. ROSE provides the opportunity to immediately assess the FNAB material for adequacy and triage the case for the most cost-effective further diagnostic procedures including immediate CNB [17, 95]. When a cytopathologist has made the provisional diagnosis at ROSE this can guide discussion with the patient, greatly reducing patient anxiety [96].…”

Section: Resultsmentioning

confidence: 99%

The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology

et al. 2019

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The International Academy of Cytology (IAC) gathered together a group of cytopathologists expert in breast cytology who, working with clinicians expert in breast diagnostics and management, have developed the IAC Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy (FNAB) Cytology. The project was initiated with the first cytopathology group meeting in Yokohama at the 2016 International Congress of Cytology. This IAC Yokohama System defines five categories for reporting breast cytology, each with a clear descriptive term for the category, a definition, a risk of malignancy (ROM) and a suggested management algorithm. The key diagnostic cytopathology features of each of the lesions within each category will be presented more fully in a subsequent atlas. The System emphasizes that the crucial requirements for diagnostic breast FNAB cytology are a high standard for the performance of the FNAB and for the making of direct smears, and well-trained experienced cytopathologists to interpret the material. The performance indicators of breast FNAB, including specificity and sensitivity, negative predictive value, positive predictive value and ROM stated in this article have been derived from the recent literature. The current practice of breast FNAB has evolved with the increasing use of ultrasound guidance and rapid on-site evaluation. Two recent publications have shown a range of ROM for the insufficient/inadequate category of 2.6–4.8%, benign 1.4–2.3%, atypical 13–15.7%, suspicious of malignancy 84.6–97.1%, and malignant 99.0–100%. The management algorithm in the System provides options because there are variations in the management of breast lesions using FNAB and core-needle biopsy in those countries utilizing the “triple test” of clinical, imaging, and FNAB assessment, and also variations in the availability of CNB and imaging in low- and middle-income countries. The System will stimulate further discussion and research, particularly in the cytological diagnostic features of specific lesions within each category and in management recommendations. This will lead to continuing improvements in the care of patients with breast lesions and possible modifications to the IAC Yokohama System.

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Section: Resultsmentioning

confidence: 99%

The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology

et al. 2019

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“…Some centres have developed rapid diagnosis as "one-stop breast clinics", providing the results of the biopsy immediately after the procedure. This type of management has been proven to be cost-effective and accurate [94]. However, efforts should be made to decrease distress and anxiety of the patients also in this setting in regards to the quality of the patient-doctor relationship and doctors' interpersonal skills, doctors' availability, and waiting time [95], which are important general aspects to be improved in breast image-guided interventions.…”

Section: Post-procedural Recommendations and Communication Of Resultsmentioning

confidence: 99%

Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging

et al. 2020

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We summarise here the information to be provided to women and referring physicians about percutaneous breast biopsy and lesion localisation under imaging guidance. After explaining why a preoperative diagnosis with a percutaneous biopsy is preferred to surgical biopsy, we illustrate the criteria used by radiologists for choosing the most appropriate combination of device type for sampling and imaging technique for guidance. Then, we describe the commonly used devices, from fine-needle sampling to tissue biopsy with larger needles, namely core needle biopsy and vacuum-assisted biopsy, and how mammography, digital breast tomosynthesis, ultrasound, or magnetic resonance imaging work for targeting the lesion for sampling or localisation. The differences among the techniques available for localisation (carbon marking, metallic wire, radiotracer injection, radioactive seed, and magnetic seed localisation) are illustrated. Type and rate of possible complications are described and the issue of concomitant antiplatelet or anticoagulant therapy is also addressed. The importance of pathological-radiological correlation is highlighted: when evaluating the results of any needle sampling, the radiologist must check the concordance between the cytology/pathology report of the sample and the radiological appearance of the biopsied lesion. We recommend that special attention is paid to a proper and tactful approach when communicating to the woman the need for tissue sampling as well as the possibility of cancer diagnosis, repeat tissue sampling, and or even surgery when tissue sampling shows a lesion with uncertain malignant potential (also referred to as "high-risk" or B3 lesions). Finally, seven frequently asked questions are answered.

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“…Respecting the patients' time by structuring and coordinated onestop initial aftercare might be the humane way to deliver all the information and ensure the compliance of the follow-up. A one-stop approach to surveillance should not compromise the quality of care based on one stop diagnostics experience (5,6). To sum up, the landmark publication of the Institute of Medicine, Crossing the Quality Chasm, defi nes high-quality cancer care as eff ective, efficient, safe, patient-centered, timely and equitable (4).…”

Section: Discussionmentioning

confidence: 99%

An argument for one day follow-up in cancer care

et al. 2019

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We wanted to assess the distribution of patients and to quantify the travel expenses for specialists' consultation in cancer care. From 1st to 31st October 2018 specialists consulted 2856 with the malignant disease at University Hospital for Tumors. We looked at rectal cancer (C20) specifi cally and identifi ed 163 rectal cancer patients. Travel expenses are derived from the following:1,35 € per kilometer for patients outside of the city of Zagreb, as denoted by the county they live in, and minimal public transport fee for the patients residing in Zagreb (2,70 €). Cost of their return transport within Zagreb was 313,2 € while 21362,16 € costed the return transport to and from the hospital from outside of Zagreb. The average cost per patient per visit 132,98 €. An estimate for 2856 patients is 379784,22 €. Transport cost for a patient being consulted on cancer care is a substantial part of not recognized costs in system analysis. The process of assessing travel costs display the area of gravitation toward a cancer center. 36% of patients were from Zagreb.

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The challenge of rapid diagnosis in oncology: Diagnostic accuracy and cost analysis of a large-scale one-stop breast clinic

Cited by 37 publications

References 22 publications

The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology

The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology

Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging

An argument for one day follow-up in cancer care

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