Correct Diagnosis of Breast Lesions by Trucut Needle Biopsy: A Key Point in Multidisciplinary Team Work Approach and Breast Cancer Patient's Bill of Right

Introduction & Revolutionary concept in the strategy of diagnosis and treatment of breast cancer in the last 30 years has significantly increased the accuracy of diagnosis and the quality of treatment while decreasing invasion to the patient. Multidisciplinary team work approach in the Specialized Breast Units is the key point in this new approach. Intimate collaboration of the breast surgeon with the interventional breast radiologist is the base of this multidisciplinary team work. In this new approach the surgeon is in a real sense the one who treats the patient. The surgery is neither acceptable for diagnosis nor for staging purpose. Rather it is done only to treat the cancer mostly as a single stage and to remove symptomatic benign breast lesions. In this study multidisciplinary team work based on this new concept and its role in increasing the accuracy of diagnosis and the quality of care while decreasing unnecessary surgery, is evaluated for the case of Iranian patients. Between March 2006 to Feb 2009, trucut biopsy was done for 505 patients with clinical suspicion and/or BIRADS III-V classification in imaging. If pathologic result and clinical suspicion were in concordance, surgery was replaced by short term follow up. Otherwise, and in the presence of moderate and severe hyperplasia, with or without atypia, lobular or papillary lesions guide wire open biopsy was done. Cancer was found in 30% of the cases (24% in stereotactic and 46% in sono-guided biopsies). Moderate and severe hyperplasia with or without atypia, lobular or papillary lesions were found in 5%. There was 2% discordance between clinical/image suspicion and pathologic result. Multidisciplinary team work approach, especially by intimate collaboration between breast surgeon and interventional breast radiologist, can eliminate the need for surgery in 63% of the cases while increasing the accuracy of diagnosis. Pre-operative tissue diagnosis will decrease the expenses of diagnosis of breast disease and breast cancer significantly by omitting unnecessary surgeries, intra-operative pathologic evaluation by frozen section and one stage cancer treatment. This approach which is especially suitable for countries with limited health budget, improves the quality of diagnosis and treatment for breast disease and especially breast cancer.