Use of an Additional Diagnostic Work-up Following a Treatment Recommendation from the Preoperative Conference of the Mammography Screening Units

 

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Abstract

Objective: If a focus of suspicion is classified as being B 3–5 by a punch biopsy as part of a mammography screening, a recommendation for further action to be taken will be given in the preoperative conference of the screening unit. As part of this investigation, these treatment recommendations were compared with the final therapeutic approach taken at a certified breast centre. Furthermore, it was investigated whether and which additional examinations were performed on patients, depending on compliance with the recommended treatment. Material and Method: The data from 272 breast cancer patients from the years 2007, 2008 and 2009 was analysed. The patients took part in the screening programmes of four screening units in the German mammography screening programme, in one federal state. In addition, the data from each patient from one screening unit was analysed in two further federal states. Results: In total, the most recently conducted intervention deviated from the treatment recommendation from the preoperative conference in the screening unit in 77 out of 272 patients (28.3 %). Of these, there were 50 recommendations for open biopsy which ultimately resulted in breast-conserving surgery, which is not to be evaluated as an error, as the bioptic result was supplemented by the open biopsy. Additional examinations were performed in patients with deviating treatment recommendation in 39 cases (50.6 %) and in patients without deviating treatment recommendation in 66 cases (34.0 %). The additional examinations carried out included additional punch biopsies (most frequent) and MRI scans, but also additional ultrasounds or a mammography. Conclusions: Additional examinations lead to a change in treatment in a higher percentage of patients in comparison with the initial screening including assessment. An exact reexamination of the findings obtained in the screening is therefore preoperatively necessary in order to guarantee optimum treatment.

Zusammenfassung

Ziel: Wird im Rahmen des Mammografie-Screenings ein verdächtiger Herd durch eine Stanzbiopsie nach B 3–5 klassifiziert, so wird in der präoperativen Konferenz der Screening-Einheit eine Empfehlung zum weiteren Vorgehen gegeben. Im Rahmen dieser Untersuchung wurden diese Therapieempfehlungen mit dem endgültigen therapeutischen Vorgehen an einem zertifizierten Brustzentrum verglichen. Weiterhin wurde untersucht, ob und welche Zusatzuntersuchungen bei den Patientinnen in Abhängigkeit von der Einhaltung der Therapieempfehlung durchgeführt wurden. Material und Methode: Analysiert wurden die Daten von 272 Mammakarzinompatientinnen aus den Jahren 2007, 2008 und 2009. Die Patientinnen nahmen am Screening-Programm vierer Screening-Einheiten eines Bundeslandes des deutschen Mammografie-Screening-Programms teil. Zudem wurden die Daten je einer Patientin aus einer Screening-Einheit zweier weiterer Bundesländer analysiert. Ergebnisse: Insgesamt weicht der letztlich durchgeführte Eingriff von der Therapieempfehlung aus der präoperativen Konferenz in der Screening-Einheit bei 77 von 272 Patientinnen (28,3 %) ab. Darunter befinden sich aber 50 Empfehlungen zur offenen Biopsie, die letztlich eine BET ergaben, was nicht als Fehler zu werten ist, da das bioptische Ergebnis durch die offene Biopsie bewusst ergänzt wurde. Zusatzuntersuchungen wurden bei Patientinnen mit abweichender Therapieempfehlung in 39 Fällen (50,6 %) durchgeführt, während es bei Patientinnen ohne abweichende Therapieempfehlung 66 (34,0 %) Fälle waren. Zu den Zusatzuntersuchungen zählten wir die erneute Stanzbiopsie (am häufigsten) und die MRT, aber auch einen erneuten US oder eine Mammografie. Schlussfolgerungen: Zusatzuntersuchungen führen im Vergleich zum initialen Screening incl. Assessment bei einem höheren Prozentsatz der Patientinnen zu einer Therapieänderung. Eine exakte Aufarbeitung der im Screening erhobenen Befunde ist daher präoperativ notwendig, um eine optimale Therapie zu gewährleisten.

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