PURPOSE: 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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
PURPOSE: 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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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: Ulrich Bick; Rubina M Trimboli; Alexandra Athanasiou; Corinne Balleyguier; Pascal A T Baltzer; Maria Bernathova; Krisztina Borbély; Boris Brkljacic; Luca A Carbonaro; Paola Clauser; Enrico Cassano; Catherine Colin; Gul Esen; Andrew Evans; Eva M Fallenberg; Michael H Fuchsjaeger; Fiona J Gilbert; Thomas H Helbich; Sylvia H Heywang-Köbrunner; Michel Herranz; Karen Kinkel; Fleur Kilburn-Toppin; Christiane K Kuhl; Mihai Lesaru; Marc B I Lobbes; Ritse M Mann; Laura Martincich; Pietro Panizza; Federica Pediconi; Ruud M Pijnappel; Katja Pinker; Simone Schiaffino; Tamar Sella; Isabelle Thomassin-Naggara; Anne Tardivon; Chantal Van Ongeval; Matthew G Wallis; Sophia Zackrisson; Gabor Forrai; Julia Camps Herrero; Francesco Sardanelli Journal: Insights Imaging Date: 2020-02-05
Authors: Joris P Bulte; Altuna Halilovic; Lambert J M Burgers; Coos J M Diepenbroek; Robin A K de la Roij; Ritse M Mann; Marloes van der Leest; Patricia H J van Cleef; Luc J A Strobbe; Johannes H W de Wilt; Peter Bult Journal: Am J Clin Pathol Date: 2020-01-01 Impact factor: 2.493