How are symptomatic services run in the United Kingdom?
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KeywordsImaging Method Fine Needle Aspiration Needle Biopsy Multidisciplinary Team Needle Aspiration
Breast clinics have developed in a fairly ad hoc way over the past 15 years, often led by experience from breast screening clinics. Although the concept of multidisciplinary teams is now well established, the interaction between members of the teams is much less well defined, particularly as to who is responsible for managing patients through the diagnostic pathway.
As part of the Association of Breast Surgery at BASO symptomatic audits that have been carried out over the past 6 years, some units have submitted data on all patients seen in their clinics, giving a dataset of over 100,000 patients from 58 breast units (median age 45, range 1–102). Overall 53% of patients have ultrasound and 57% mammography, with both imaging methods used in 32%. Needle biopsies (core or fine needle aspiration cytology) are carried out on 26% of patients, with 69% showing benign pathology. The pre-operative cancer diagnosis rate is 91%.
This dataset has been explored to look at variation in practice across units, and shows quite wide variation in the reported use of mammo-graphy (26–100%), ultrasound (4–96%), and needle biopsy (6–57%), although this does not obviously alter the cancer diagnosis rates for individual units. These results will be presented to inform discussion on what may be best practice.