Bibliothek

Notizen: Abstract: The objective of this study was to compare the accuracy of current methods of determining clip location (immediate stereotactic images versus postprocedure two-view mammograms) after stereotactic-guided, vacuum-assisted breast biopsy (VABB). Retrospective review was made of 101 lesions for which a localizing clip was placed during stereotactic VABB. Clip-to-lesion distances were measured by 1) stereotactic images (x, y, and z coordinates), and 2) postbiopsy two-view mammograms compared to prebiopsy two-view mammograms. The mean clip-to-lesion distance was 5.7 mm from stereotactic images, while the mean clip-to-lesion distances were 3.6 and 9.4 mm from same-view and orthogonal-view mammogram measurements, respectively. Stereotactic coordinate measurements compared to orthogonal-view mammogram clip-to-lesion measurements showed a significant difference (p 〈 0.001), as did the same-view mammogram compared to both stereotactic images and orthogonal-view mammogram (p 〈 0.001). The number of clips found to be less than 20 mm from the lesion (defined as clinically significant) was significantly higher for measurements from orthogonal-view mammograms (n = 19) compared to both stereotactic images (n = 0) and same-view mammograms (n = 5) (p 〈 0.001). Determination of clip location based on stereotactic images significantly underestimated the clip-to-lesion distance. Stereotactic images obtained at the conclusion of clip placement during VABB are not reliable in determining clip location relative to the targeted lesion. Although stereotactic images can confirm deployment of the clip, a two-view postbiopsy mammogram is necessary to determine clip location relative to the targeted lesion. 

Notizen: Abstract: Among women around the globe, breast cancer is both the most common cancer and the leading cause of cancer-related death. Women in economically disadvantaged countries have a lower incidence of breast cancer, but poorer survival rates for the disease relative to women in affluent countries. Evidence suggests that breast cancer mortality can be reduced if resources are applied to the problem in a systematic way. The purpose of the Global Summit Consensus Conference was to begin a process to develop guidelines for improving breast health care in countries with limited resources—those with either low- or medium-level resources based on World Health Organization (WHO) criteria. Breast cancer experts and patient advocates representing 17 countries and 9 world regions participated in the conference. They reviewed the existing breast health guidelines, which generally assume unlimited resources. Individual panels then discussed and debated how limited resources can best be applied to improve three areas of breast health care—early detection, diagnosis, and treatment—and how to integrate these areas in building a breast health care program. The panelists unanimously agreed on the guiding principle that all women have the right to access to health care. They also agreed that collecting data on breast cancer is imperative for deciding how best to apply resources and for measuring progress. The panelists acknowledged the considerable challenges in implementing breast health care programs when resources are limited, as well as the need to build a program that is specific to each country's unique situation. The panelists noted that the development of centralized, specialized cancer centers may be a cost-effective way to deliver breast cancer care to some women when it is not possible to deliver such care to women nationwide. In countries with limited resources, at least half of the women have advanced or metastatic breast cancer at the time of diagnosis. Because advanced breast cancer has the poorest survival rate and is the most resource intensive to treat, measures to reduce the stage at diagnosis are likely to have the greatest overall benefit in terms of both survival and costs. Women should have access to diagnosis and treatment if efforts are undertaken to improve early detection of breast cancer. The panels’ findings outline specific steps for prioritizing the use of limited resources to decrease the impact of breast cancer around the globe. 

Notizen: Abstract: Accurate diagnosis is a necessary step in the management of breast cancer. In women with breast cancer, diagnosis can confirm the presence of the disease, reduce treatment delays, and clarify the predictive and prognostic features of the cancer, which help in planning treatment and counseling women. In women with benign breast conditions, accurate diagnosis avoids erroneous treatment for breast cancer, which can have devastating consequences for the woman and unnecessarily consumes resources. The panel distinguishes between a “clinical diagnosis” of breast cancer (one based on signs and symptoms and imaging findings) and a “pathologic diagnosis” of breast cancer (one based on microscopic examination of cellular or tissue samples). The panel agrees that all women should have a pathologic diagnosis of breast cancer before they are given definitive treatment for the disease, no matter how strongly their clinical findings suggest cancer. The tools for clinical diagnosis include history, clinical breast examination, ultrasound, and diagnostic mammography; these tools provide valuable information and play important supplemental roles in ascertaining the presence of breast cancer. Mammography and ultrasound also help determine the extent of disease within the breast, which is essential when breast-conserving therapy can be offered to women. The tools for pathologic diagnosis include fine-needle aspiration biopsy, core needle biopsy, and standard surgical biopsy. The panel noted that each of these tools has potential benefits and limitations in the limited-resource setting, and concluded that the choice among them must be based on the available tools and expertise. The triple test—checking for correlation of pathology findings, imaging findings, and clinical findings—was identified as a critical practice in diagnosing breast cancer. Panelists uniformly agreed that mastectomy should not be used to diagnose breast cancer, noting that accurate diagnosis can be made by less invasive means. Expertise in pathology was identified as a key requirement for ensuring reliable diagnostic findings. Several approaches were proposed for improving breast pathology, including training pathologists, establishing pathology services in centralized facilities, and organizing international pathology services.