Assessing variability in breast cancer management across the world: results of a questionnaire survey amongst global international experts in breast cancer management

Background

Breast cancer is the most common cancer in women worldwide with an estimated 2.3 million breast cancer cases diagnosed annually. The outcome of breast cancer management varies widely across the globe which could be due to a multitude of factors. Hence, a blanket approach in standardisation of care across the world is neither practical nor feasible.

Aim

To assess the extent and type of variability in breast cancer management across the globe and to do a gap analysis of patient care pathway.

Method

An online questionnaire survey and virtual consensus meeting was carried out amongst 31 experts from 25 countries in the field of breast cancer surgical management. The questionnaire was designed to understand the variability in diagnosis and treatment of breast cancer, and potential factors contributing to this heterogeneity.

Result

The questionnaire survey shows a wide variation in breast surgical training, diagnosis and treatment pathways for breast cancer patients. There are several factors such as socioeconomic status, patient culture and preferences, lack of national screening programmes and training, and paucity of resources, which are barriers to the consistent delivery of high-quality care in different parts of the world.

Conclusion

On-line survey platforms distributed to global experts in breast cancer care can assess gaps in the diagnosis and treatment of breast cancer patients. This survey confirms the need for an in-depth gap analysis of patient care pathways and treatments to enable the development of personalised plans and policies to standardise high quality care.

Feasibility of preoperative (125)I seed-guided tumoural tracer injection using freehand SPECT for sentinel lymph node mapping in non-palpable breast cancer

Background

This study was designed to explore the feasibility of replacing the conventional peri-/intratumoural ultrasound (US)-guided technetium-99m albumin nanocolloid (^99mTc-nanocolloid) administration by an injection of the same tracer guided by a freehand single-photon emission computed tomography (SPECT) device in patients with non-palpable breast cancer with an iodine-125 (¹²⁵I) seed as tumour marker, who are scheduled for a sentinel lymph node biopsy (SLNB). This approach aimed to decrease the workload of the radiology department, avoiding a second US-guided procedure.

Methods

In ten patients, the implanted ¹²⁵I seed was primarily localised using freehand SPECT and subsequently verified by conventional US in order to inject the ^99mTc-nanocolloid. The following 34 patients were injected using only freehand SPECT localisation. In these patients, additional SPECT/CT was acquired to measure the distance between the ^99mTc-nanocolloid injection depot and the ¹²⁵I seed. In retrospect, a group of 21 patients with US-guided ^99mTc-nanocolloid administrations was included as a control group.

Results

The depth difference measured by US and freehand SPECT in ten patients was 1.6 ± 1.6 mm. In the following 36 ¹²⁵I seeds (34 patients), the average difference between the ¹²⁵I seed and the centre of the ^99mTc-nanocolloid injection depot was 10.9 ± 6.8 mm. In the retrospective study, the average distance between the ¹²⁵I seed and the centre of the ^99mTc-nanocolloid injection depot as measured in SPECT/CT was 9.7 ± 6.5 mm and was not significantly different compared to the freehand SPECT-guided group (two-sample Student's t test, p = 0.52).

Conclusion

We conclude that using freehand SPECT for ^99mTc-nanocolloid administration in patients with non-palpable breast cancer with previously implanted ¹²⁵I seed is feasible. This technique may improve daily clinical logistics, reducing the workload of the radiology department.