Logistics of referral, diagnostic assessment and treatment of patients with breast symptoms and signs.
OBJECTIVE
The logistics of diagnosis and treatment in a hospital with slightly above 400 new cases of breast cancer per year is analysed.


METHODS
The patient flow from referral, through the diagnostic procedures and through surgical treatment is described.


CONCLUSIONS
The basic principle of the diagnostic assessment is the triple diagnostic procedure including mammography supplemented by ultrasonography, fine needle aspiration cytology and clinical examination. The radiologist and pathologist are working together in the breast diagnostic centre and are thus able to give a "single visit diagnosis" in most cases. The surgeon sees the patient either the same day or the next. A "consensus meeting" held each week with representatives for all specialities present has an important function in quality assurance and education. If one or more of the triple diagnostic components reach conclusion level "suspicious lesion", surgery is indicated. In hospital management is based on day surgery for all biopsies, wide excisions with or without sentinel node and some ablatio simplex mammae. For wide excision and ablation with complete axillary node clearance, the patients are transferred from the day surgery unit to a patient hotel after 3-4 hours of observation and stay till the drain can be removed. Only in rare case of high cardiopulmonary risk, beds in ordinary wards are used. This is a highly cost efficient logistic saving the hospital approximately 400,000 EUR a year compared to ordinary in hospital treatment.
Kåresen
R
R
Department of General surgery, Ullevaal University Hospital, Norway. rolf.karesen@ulleval.no
Jensen
H H
HH
Sauer
T
T
Schlichting
E
E
Skaane
P
P
Wang
H
H
D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D003954:Diagnostic Services / Q000458:organization & administration*; D005260:Female; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D008408:Mastectomy; D009934:Organization and Administration; D012017:Referral and Consultation / Q000458:organization & administration*