Red breast as a presenting complaint at a breast center: an institutional review.

BACKGROUND: The differential diagnosis of a red breast is extensive and includes both benign and malignant diseases. The literature documents patients who present with a red breast with delays in diagnosis of inflammatory cancer. We recorded our institutional experience prospectively in the evaluation, diagnosis, and treatment of a red breast. METHODS: Data were collected prospectively on patients who presented with a red breast during a 14-month period. A retrospective review of final diagnosis and outcome was then conducted. A PubMed and Ovid Medline literature search were performed. RESULTS: Twenty-two patients presented with a red breast. This number accounted for only 0.6% (22/3,762) of patients evaluated in our breast center during this time period. Final diagnoses were as follows: mastitis in 31.8%, breast abscess in 13.6%, erythematous changes secondary to radiation therapy in 13.6%, cellulitis in 9.1%, and venous hypertension in 9.1%. Other diagnoses included postradiation morphea, benign dermatologic inflammation, Paget disease of the breast, inflammatory breast cancer, and psoriasis (1 patient each). After treatment, 67% (17/22) patients had resolution of their symptoms and 18% (4/22) were improved. Only 1 (4.5%) of 22 patients had a change in diagnosis in a median follow-up of 8.8 months. CONCLUSION: A red breast is an uncommon presenting complaint in patients evaluated at a breast center; however, the differential diagnosis is extensive. With appropriate diagnosis and treatment, most patients will have improvement or resolution of their symptoms. The diagnostic algorithm used by our breast center identified the cause of the red breast correctly in >95% of patients at presentation, and it can serve as a guide to evaluate patients with a red breast. This algorithm is in agreement with National Comprehensive Cancer Network guidelines.

Local and paravertebral block anesthesia for outpatient elective breast cancer surgery.

Most breast cancer operations in the United States are performed with the patient given general anesthesia. We retrospectively reviewed our prospective breast cancer database to determine the percentage of patients who underwent breast cancer operations with either local or paravertebral block regional anesthesia from January 1 through June 30, 2008. Fifty-two of 70 patients (74%) were able to undergo breast cancer surgery with local or paravertebral block regional anesthesia. Operations included mastectomy, full axillary dissections, and expander or implant reconstruction. There were no conversions to general anesthesia and no unplanned overnight admissions. Only 5 of 52 patients (10%) undergoing surgery with local or paravertebral block regional anesthesia developed postoperative nausea or vomiting. We conclude that most elective outpatient breast cancer surgery operations can be performed with the patients given local or regional anesthesia.

A quality review of the timeliness of breast cancer diagnosis and treatment in an integrated breast center.

BACKGROUND: The National Consortium of Breast Centers defines "quality" of breast cancer care as "accurate evaluation and appropriate services ... in a timely manner." We sought to determine timeliness of care and relationship to patient satisfaction. STUDY DESIGN: The electronic medical records of breast cancer patients seen at a breast center from 2004 through 2007 were retrospectively reviewed. Dates of patient service were audited. A postal survey was then conducted to determine patient satisfaction with timeliness. RESULTS: Median time interval in business days from abnormal screening mammogram to diagnostic evaluation and core needle biopsy was 6 days. Median time intervals from core needle biopsy to core needle biopsy pathology report and then subsequent surgical consultation and breast cancer operation were 1, 3, and 7 days, respectively. Breast MRI, systemic imaging, plastic surgery consultation, type of surgery, and patient choice prolonged time to treatment. More than 90% of breast cancer patients who responded to our postal survey had their expectations met or exceeded for the dates of service provided for diagnostic evaluation and treatment. CONCLUSIONS: Evaluation of timeliness as a quality indicator for breast cancer care is complex and requires an assessment of whether patient expectations were met for dates of service. Factors that prolong time to treatment, such as additional imaging, should be considered for risk adjustment for peer performance comparison and compliance with published timeliness target goals.