ABSTRACT
Diagnostic assessment programmes (DAPs) coordinate multidisciplinary teamwork (MDT), and improve wait times and patient satisfaction. No research has established optimal DAP design. This study explored how DAP characteristics influence service delivery. A mixed methods case study of four breast cancer DAPs was conducted including qualitative interviews with health-care providers and retrospective chart review. Data were integrated using multiple approaches. Twenty-three providers were interviewed; 411 medical records were reviewed. The number of visits and wait times from referral to diagnosis and consultation were lowest at a one-stop model. DAP characteristics (rural-remote region, human resources, referral volume, organisation of services, adherence to service delivery targets and one-stop model) may influence service delivery (number of visits, wait times). MDT, influenced by other DAP characteristics (co-location of staff, patient navigators, team functioning), may also influence service delivery. While the one-stop model may be ideal, all sites experienced similar and unique challenges. Further research is needed to understand how to optimise the organisation and delivery of DAP services. Measures reflecting individual, team and patient-reported outcomes should be used to assess the effectiveness and impact of DAPs in addition to more traditional measures such as wait times.
Subject(s)
Breast Neoplasms/diagnosis , Delivery of Health Care , Patient Care Team/organization & administration , Adult , Aged , Delivery of Health Care/organization & administration , Delivery of Health Care/standards , Female , Humans , Middle Aged , Patient Satisfaction , Program Evaluation , Qualitative Research , Retrospective Studies , Young AdultABSTRACT
OBJECTIVES: The purpose of this study was to evaluate the performance of a direct computer-aided detection (d-CAD) system integrated with full-field digital mammography (FFDM) in assessment of amorphous calcifications. METHODS: From 1438 consecutive stereotactic-guided biopsies, FFDM images with amorphous calcifications were selected for retrospective evaluation by d-CAD in 122 females (mean age, 56 years; range, 35-84 years). The sensitivity, specificity, accuracy and false-positive rate of the d-CAD system were calculated in the total group of 124 lesions and in the subgroups based on breast density, mammographic lesion distribution and extension. Logistic regression analysis was used to stratify the risk of malignancy by patient risk factors and age. RESULTS: The d-CAD marked all (36/36) breast cancers, 85% (11/13) of the high-risk lesions and 80% (60/75) of benign amorphous calcifications (p<0.01) correctly. The sensitivity, specificity and diagnostic accuracy for the combined malignant and "high-risk" lesions was 96, 80 and 86%, respectively. The likelihood of malignancy was 29%. There was no significant difference between the marking of fatty or dense breasts (p>0.05); however, d-CAD marks showed differences for small (<7 mm) lesions (p=0.02) and clustered calcifications (p=0.03). The false-positive rate of d-CAD was 1.76 marks per full examination. CONCLUSION: The d-CAD system correctly marked all biopsy-proven breast cancers and a large number of biopsy-proven high-risk lesions that presented as amorphous calcifications. Given our 29% likelihood of malignancy, imaging-guided biopsy appears to be a reasonable recommendation in cases of amorphous calcifications marked by d-CAD.
Subject(s)
Breast Diseases/diagnostic imaging , Calcinosis/diagnostic imaging , Mammography/methods , Radiographic Image Interpretation, Computer-Assisted/methods , Adult , Aged , Aged, 80 and over , Breast Neoplasms/diagnostic imaging , Female , Humans , Middle Aged , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Granular cell tumours (GCTs) are uncommon, usually benign neoplasms that can mimic malignancy on breast imaging. GCTs can originate anywhere in the body but are most frequently found in the head and neck area, particularly in the oral cavity. When occurring in the breast, as occurs in 5-8% of all cases of GCT, the clinical presentation is similar to that of a primary breast carcinoma. We report a case of granular cell tumour of the breast presenting as a suspicious lesion on breast imaging, and review the MRI features of GCTs.
Subject(s)
Breast Neoplasms/diagnosis , Granular Cell Tumor/diagnosis , Biopsy , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Female , Granular Cell Tumor/diagnostic imaging , Granular Cell Tumor/pathology , Humans , Magnetic Resonance Imaging , Mammography , Middle AgedABSTRACT
OBJECTIVE: To determine the sensitivity and specificity of magnetic resonance imaging (MRI) of the breast for detecting recurrent carcinoma. PATIENTS AND METHODS: Thirteen patients ranging in age from 47 to 77 years who had undergone lumpectomy 5 months to 8 years earlier and who had mammographic findings suggestive of recurrence underwent contrast-enhanced dynamic MRI. Histologic confirmation was obtained in all cases. RESULTS: Of the eight lesions (in seven patients) for which biopsy proved recurrence, MRI correctly identified six; there were two false negative results. Of the six benign lesions, four were correctly identified by MRI. The two false positive results involved fat necrosis and a foreign-body reaction respectively. CONCLUSION: These results confirm previous reports of the poor specificity of MRI of focal breast lesions. The authors therefore recommend caution in the use of breast MRI in the assessment and management of suspected recurrent carcinoma.
