Chapter 1 - Diagnosis and Staging of Breast Cancer and Multidisciplinary Team Working
- Frequent BC symptoms and signs include a palpable breast lump, skin or nipple retraction, bloody discharge from the nipple, changes in breast size or shape, skin rash, ulceration, erythema and eczema of the nipple–areola complex
- The gold standard for diagnosis is the triple diagnostic approach consisting of clinical examination, breast imaging and needle biopsy of suspicious lesions
- The diagnostic accuracy of CNB is superior when compared with FNAC. Moreover, hormone receptor and HER2 status can be determined from CNB, especially relevant if neoadjuvant systemic treatment is considered
- Breast MRI is beneficial when planning breast conservation in patients with invasive lobular cancer, when assessing response to neoadjuvant treatment and in surveillance of high-risk women with genetic propensity for BC
- Axillary ultrasound and needle biopsy from suspicious nodes is an essential part of the diagnostic procedure
- Sentinel node biopsy is the gold standard in patients without evidence of axillary nodal metastases in the pre-treatment ultrasound examination of the axilla
- Staging by imaging to detect distant metastases is considered for high-risk patients
- PET-CT scan may detect distant metastases undetected by other imaging methods but should not be used routinely
- The pathologist’s report should include all data needed for the planning of further locoregional and systemic adjuvant treatments. As a minimum: histological type and grade of invasive cancer, size, lymph nodes, lymphovascular invasion, oestrogen receptor, progesterone receptor, HER2 and cell proliferation
- The main goal of the multidisciplinary team meeting is to optimise the treatment for each patient. It is mandatory for all BC patients
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Kesson EM, Allardice GM, George WD, et al. Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. BMJ 2012; 344:e2718.
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