Comment on: The EUSOMA Position Paper on the requirements of a specialist breast unit, Eur J Cancer 2000, 36, 2288-2293

Organizational and welfare mode of breast centers network: a survey of Sicilian radiologists

The European Society of Breast Cancer Specialists has created quality indicators for breast units to establish the minimum standards of care for patients. In Italy, each region differs, indeed, in terms of health care and services warranted to patients suffering from breast cancer. Since Sicilian Regional Administration today is still disregarding implementation of the provisions contained in the proposal of the Ministry of Health entitled "Guidelines on Organizational and Health Care Methods of Breast Centers Network" in November 2015 the Sicilian Regional Group of the Italian Society of Radiology (SIRM) decided to carry out a survey to see the position of the Sicilian Healthcare System and define the gap to bridge over. Sicilian breast imaging radiologists were asked to fill in a questionnaire concerning the type of job relationship (public or private sector), qualification (Manager, Department Manager, Freelancer) and years of experience on breast imaging. With regard to technological requirements, were answered the questions about the number, type, age and completeness of accessories of the equipment supplied in the Sicilian healthcare facilities. The data showed that over 64% of breast imagers in Sicilian centers work in breast units, whereas only 18% are involved in screening programs. A majority of radiologists (81%) working in the breast health care system is very experienced (more than 10 years of experience in the field). The result provided concerning the medical and technical staff demonstrates an uneven situation, but overall an inadequate value compared with the required guidelines especially in interventional procedures. The aim of this paper is to illustrate the method used and the results obtained. These data have to be shared with policy makers to enhance quality improvement in Sicilian Breast Center Network.

Axillary ultrasound for breast cancer staging: an attempt to identify clinical/histopathological factors impacting diagnostic performance

Aim:

To assess the diagnostic value of pre-surgery axillary ultrasound for nodal staging in patients with primary breast cancer and to identify clinical/histopathological factors impacting diagnostic performance.

Study design:

Single-center, retrospective chart analysis. We assessed sensitivity, specificity, and positive and negative predictive value of clinical examination as well as axillary ultrasound vs. clinical examination alone. The histopathological results were the standard of truth. In addition, we analyzed clinical and histopathological factors regarding their potential to impact sensitivity and specificity.

Results:

We enrolled a total of 172 women in the study. Sensitivity of clinical examination plus ultrasound was significantly higher than for clinical examination alone (58% vs. 31.6%). Specificity and positive predictive value were similar while the negative predictive value increased from 63.4% to 73% when additionally applying ultrasound. Sensitivity and specificity of axillary ultrasound were impacted by tumor size (P = 0.2/0.04), suspicious axillary palpation (P < 0.01/<0.01), number of affected lymph nodes (P < 0.01/−) and distant metastases (P = 0.04/<0.01). All other factors had no impact.

Conclusion:

Since pre-surgery axillary nodal staging is currently used to determine disease management, axillary ultrasound is a useful add-on tool in the diagnostic armamentarium for breast cancer patients. Tumor size, suspicious axillary palpation, number of affected lymph nodes and distant metastases increase diagnostic performance of this diagnostic modality.

Breast Units in Europe - Certification in 9 European Countries 9 Years after the European Society of Mastology Position Paper

SUMMARY: INTRODUCTION: We aimed to take a snapshot of breast units in the European Union 9 years after the publication of the European Society of Mastology (EUSOMA) position paper. METHODS: In order to obtain information on breast units throughout the European Union, we designed a questionnaire comprising 5 questions on certification, audit frequency and number of breast units in each country. Our primary contacts were national cancer societies, breast cancer study groups, breast cancer organizations, national associations and societies of breast treatment, as well as experts in the field of breast cancer. RESULTS: Information on characteristics of the certification process and number of breast units was obtained for 9 countries of the European Union. 7 of the 9 countries (78%) have a certification process of the breast units. Certification is carried out by public authorities in 4 (57%) countries and by private companies in 3 (43%) countries. Information on frequency of auditing was reported in 4 countries and varied between annual audits (Austria, Ireland and Germany) and audits once every 3 years (United Kingdom). CONCLUSIONS: The current study suggests that the European breast unit landscape is a heterogeneous field. 9 years after the EUSOMA position paper, we do not have any standard European guidelines, neither for the development nor for the mandatory prerequisites of a breast unit. The development and operation of breast units are still country specific.