[Medical logistics: principles applied to diagnostics and therapy in women with symptoms and signs of breast cancer].
BACKGROUND
Using breast cancer as an example, we suggest that medical logistics should be introduced as a method for continuous improvement of quality and cost-effectiveness in the health care system.


METHODS
Ullevaal University Hospital has approximately 500 newly diagnosed cases of breast cancer per year. The triple diagnostic test supplemented by MRI are the diagnostic tools. We rely on fine needle aspiration cytology as the only morphological test before surgery, which is done as day surgery. 70 % of the patients return home on the same day, the others stay in a patient hotel until the drains can be removed. The sentinel node procedure is routine and has been done on 610 patients.


RESULTS
Of 1502 radically operated, 2 had false positive cytology (0.12 per cent). Of 610 sentinel node cases, 91 % were found; of these, 23 % had metastasis. Among the negative cases, two have so far experienced recurrence of the disease in the axilla. The patients are well satisfied. Total yearly savings compared to the era before sentinel node and use of a patient hotel has been calculated to approximately 400 000 euro.


CONCLUSIONS
We find our results so far acceptable as regards the use of fine needle aspiration cytology as well as the sentinel node. Both techniques are, however, technically demanding and should only be used in centres that have continuous quality monitoring.
Kåresen
Rolf
R
Gastrokirurgisk avdeling, Ullevål universitetssykehus, 0407 Oslo. rolf.karesen@ulleval.no
Hervik
Arild
A
Schlichting
Ellen
E
D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003362:Cost-Benefit Analysis; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007902:Length of Stay; D008327:Mammography; D009664:Norway; D010347:Patient Care Planning / Q000191:economics / Q000592:standards; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care; D021701:Sentinel Lymph Node Biopsy; D012944:Social Support