title: The challenge of rapid diagnosis in oncology: Diagnostic accuracy and cost analysis of a large-scale one-stop breast clinic.
abstract: Rapid diagnosis is a key issue in modern oncology, for which one-stop breast clinics are a model. We aimed to assess the diagnosis accuracy and procedure costs of a large-scale one-stop breast clinic.
  
  
  
  A total of 10,602 individuals with suspect breast lesions attended the Gustave Roussy's regional one-stop breast clinic between 2004 and 2012. The multidisciplinary clinic uses multimodal imaging together with ultrasonography-guided fine needle aspiration for masses and ultrasonography-guided and stereotactic biopsies as needed. Diagnostic accuracy was assessed by comparing one-stop diagnosis to the consolidated diagnosis obtained after surgery or biopsy or long-term monitoring. The medical cost per patient of the care pathway was assessed from patient-level data collected prospectively.
  
  
  
  Sixty-nine percent of the patients had masses, while 31% had micro-calcifications or other non-mass lesions. In 75% of the cases (87% of masses), an exact diagnosis could be given on the same day. In the base-case analysis (i.e. considering only benign and malignant lesions at one-stop and at consolidated diagnoses), the sensitivity of the one-stop clinic was 98.4%, specificity 99.8%, positive and negative predictive values 99.7% and 99.0%. In the sensitivity analysis (reclassification of suspect, atypical and undetermined lesions), diagnostic sensitivity varied from 90.3% to 98.5% and specificity varied from 94.3% to 99.8%. The mean medical cost per patient of one-stop diagnostic procedure was €420.
  
  
  
  One-stop breast clinic can provide timely and cost-efficient delivery of highly accurate diagnoses and serve as models of care for multiple settings, including rapid screening-linked diagnosis.
authors: Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France. Electronic address: suzette.delaloge@gustaveroussy.fr.
authors: Suzette
authors: S
authors: Delaloge
authors: Gustave Roussy, Université Paris-Saclay, Department of Biostatistics, Epidemiology and Health Economics, Villejuif, F-94805, France; INSERM U1018, CESP Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Université Paris-Saclay, Villejuif, France.
authors: Julia
authors: J
authors: Bonastre
authors: Gustave Roussy, Université Paris-Saclay, Department of Biostatistics, Epidemiology and Health Economics, Villejuif, F-94805, France; INSERM U1018, CESP Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Université Paris-Saclay, Villejuif, France.
authors: Isabelle
authors: I
authors: Borget
authors: Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France.
authors: Jean-Rémi
authors: JR
authors: Garbay
authors: Gustave Roussy, Université Paris-Saclay, Department of Biostatistics, Epidemiology and Health Economics, Villejuif, F-94805, France; INSERM U1018, CESP Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Université Paris-Saclay, Villejuif, France.
authors: Rachel
authors: R
authors: Fontenay
authors: Gustave Roussy, Université Paris-Saclay, Department of Supportive Care, Villejuif, F-94805, France.
authors: Diane
authors: D
authors: Boinon
authors: Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France.
authors: Mahasti
authors: M
authors: Saghatchian
authors: Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France.
authors: Marie-Christine
authors: MC
authors: Mathieu
authors: Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France.
authors: Chafika
authors: C
authors: Mazouni
authors: Gustave Roussy, Université Paris-Saclay, Department of Radiation Therapy, Villejuif, F-94805, France.
authors: Sofia
authors: S
authors: Rivera
authors: Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France.
authors: Catherine
authors: C
authors: Uzan
authors: Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France.
authors: Fabrice
authors: F
authors: André
authors: Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France.
authors: Clarisse
authors: C
authors: Dromain
authors: Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France.
authors: Bruno
authors: B
authors: Boyer
authors: Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France.
authors: Barbara
authors: B
authors: Pistilli
authors: Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France.
authors: Sandy
authors: S
authors: Azoulay
authors: Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France.
authors: Françoise
authors: F
authors: Rimareix
authors: Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France.
authors: El-Hadi
authors: el-H
authors: Bayou
authors: Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France.
authors: Benjamin
authors: B
authors: Sarfati
authors: Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France.
authors: Hélène
authors: H
authors: Caron
authors: Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France.
authors: Amal
authors: A
authors: Ghouadni
authors: Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France.
authors: Nicolas
authors: N
authors: Leymarie
authors: Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France.
authors: Sandra
authors: S
authors: Canale
authors: Gustave Roussy, Université Paris-Saclay, Department of Medical Information, Villejuif, F-94805, France.
authors: Muriel
authors: M
authors: Mons
authors: Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France.
authors: Julia
authors: J
authors: Arfi-Rouche
authors: Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France.
authors: Monica
authors: M
authors: Arnedos
authors: Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France.
authors: Voichita
authors: V
authors: Suciu
authors: Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France.
authors: Philippe
authors: P
authors: Vielh
authors: Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France.
authors: Corinne
authors: C
authors: Balleyguier
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics; D018567:Breast Neoplasms, Male / Q000175:diagnosis / Q000191:economics; D002173:Cancer Care Facilities / Q000191:economics / Q000592:standards; D003365:Costs and Cost Analysis; D055088:Early Detection of Cancer / Q000191:economics / Q000592:standards; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems / Q000191:economics / Q000592:standards; D011446:Prospective Studies; D012680:Sensitivity and Specificity
keywords: Breast cancer; Cost analysis; Diagnosis; One-stop clinic; Sensitivity; Specificity