Patient-led breast cancer follow up

Patient-led breast cancer follow up
D. Chapman, E. Cox, P.D. Britton, G.C. Wishart
The Breast 2009 18 (2): 100-102

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The introduction of PLFU has been well received by patients at low risk of breast cancer recurrence or death without a marked increase in GP workload. The use of risk stratification allows low risk patients to undergo five-year mammographic surveillance without regular breast examination but with access to clinical input if necessary. It also allows time to be spent with those patients at higher risk of recurrence as well as an increasing flow of new referrals with symptomatic disease.

Introduction of this model will comply with NICE guidelines to reduce unnecessary breast cancer follow up and contribute to UK breast units achieving the government target to see all breast cancer referrals within two weeks in the near future. The introduction of PLFU should therefore be considered by all breast units in the UK

Ultrasound-guided vacuum assisted breast biopsy in the assessment of C3 breast lesions by ultrasound-guided fine needle aspiration cytology: Results a

Ultrasound-guided vacuum assisted breast biopsy in the assessment of C3 breast lesions by ultrasound-guided fine needle aspiration cytology: Results and costs in comparison with surgery
Francesca Abbate, Lorenzo Bacigalupo, Antuono Latronico, Chiara Trentin, Silvia Penco, Simona Menna, Giuseppe Viale, Enrico Cassano, Massimo Bellomi
The Breast 2009, 18 (2):73-77

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In our experience, US-guided VABB appears to be an accurate and cost-effective modality compared to surgery for the evaluation of lesions which are found to be C3 (indeterminate) at US-guided FNAC. In particular, considering the low percentage of malignant cases in this series (18/138 = 13%), surgical biopsy may be avoided in most cases. This diagnostic approach would allow surgery to be restricted to the treatment to malignant lesions and, in a few selected patients, to confirm or further investigate VABB findings.

Still the choice of using VABB to assess US visible C3 lesions might be excessive as core biopsy might be used as an alternative, more studies comparing VABB and core biopsy to assess C3 cases are needed before VABB may be recommended as the ideal option

Mammographic density estimation: Comparison among BI-RADS categories, a semi-automated software and a fully automated one

Mammographic density estimation: Comparison among BI-RADS categories, a semi-automated software and a fully automated one
Alberto Tagliafico, Giulio Tagliafico, Simona Tosto, Fabio Chiesa, Carlo Martinoli, Lorenzo E. Derchi, Massimo Calabrese
The Breast 18, 1, February 2009, Pages 35-40

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Part of the BIRADS report is an estimation of breast density in 4 grades from fatty to extremely dense (as an indicator of the sensitivity of mammography to pick up cancers). This study compared standard reading with that obtained from semi-automated and fully automated breast density reporting software. Fully automated was better than semi-automated, which was also better than conventional density estimation.

This technique has the potential to eliminate the reader variability in reading out density for a particular mammogram

Ultrasound guided percutaneous axillary lymph node core biopsy: How often is the sentinel lymph node being biopsied?

Ultrasound guided percutaneous axillary lymph node core biopsy: How often is the sentinel lymph node being biopsied?
P.D. Britton, E. Provenzano, S. Barter, M. Gaskarth, A. Goud, P. Moyle, R. Sinnatamby, M. Wallis, J.R. Benson, P. Forouhi, G.C. Wishart
The Breast 18, 1, 2009, 13-16

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This study aimed to establish the frequency of successful targeting of the SLN by ultrasound guided biopsy. False negative rate for CB of 30%. Reasons for false -ves - failure to sample the sentinel lymph node in 10 (45%) and failure to sample the metastatic disease in the sentinel node in 11 (55%). Better methods of identifying the sentinel lymph node and more adequate sampling are required

Predictive value of needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

Predictive value of needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening
M E El-Sayed, E A Rakha, J Reed, A H S Lee, A J Evans, I O Ellis
Histopathology 2008, 53, 650–657

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Approximately 20% of needle core biopsy of screen-detected breast lesions classified as B3 are malignant on excision, and the likelihood of malignancy varies substantially between different histological subtypes

Lobular neoplasia: Core needle breast biopsy underestimation of malignancy in relation to radiologic and pathologic features
Viviana Londero, Chiara Zuiani, Anna Linda, Elena Vianello, Alessandro Furlan, Massimo Bazzocchi
The Breast 17 (2008) 623 - 630

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Purpose: to assess the positive predictive value (PPV) for malignancy of core needle biopsy (CNB) demonstrating lobular neoplasia.
Underestimation of malignancy was more likely in cases of LCIS, US-guided CNB, and lesions that were large and suspicious on imaging.

The value of a combination of wire localization and ultrasound-guided vacuum-assisted breast biopsy for clustered microcalcifications

The value of a combination of wire localization and ultrasound-guided vacuum-assisted breast biopsy for clustered microcalcifications
Ki Seok Choo, Hee Suk Kwak, Young Tae Bae, Jee-Yeon Lee, Seung Ju Lee, Hyoung Il Seo, Su Bong Nam
The Breast 17 (2008) 611 - 616

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Purpose: to introduce and evaluate the usefulness of the combination of wire localization and ultrasound (US)-guided, vacuum-assisted breast biopsy (VAB) to histologically diagnose mammographically detected clustered microcalcifications in the absence of sonographic and clinically palpable masses. Appears to be an accurate and useful method for diagnosing mammographically detected, clustered microcalcifications