Imaging in symptomatic breast disease

An audit to assess compliance with imaging guidelines within the symptomatic breast clinic. It is based on the 'Best practice guidelines for patients presenting with breast symptoms' published in 2010 [1].

Women with breast disease who require specialist opinion should be seen in a multi-disciplinary breast clinic where triple assessment (clinical assessment, imaging and needle cytology/histology) is available. Efficient and effective imaging is usually only achieved through the implementation of agreed protocols such as the 'Best practice guidelines for patients presenting with breast symptoms' [1].

The standard: 

1. Available imaging facilities should include x-ray mammography and high frequency ultrasound with probes suitable for breast imaging (12MHz or more)

2. Imaging should be carried out by suitably trained members of the multidisciplinary team eg. radiologist, radiographer, breast clinician, nurse, surgeon

3. If Imaging is indicated -

   a. Those aged less than 40 years should have ultrasound as the initial imaging modality; ultrasound is also the imaging method of choice during pregnancy or lactation

   b. Those aged 40 years or above should have mammography as the initial imaging modality

   c. The level of suspicion for malignancy should be recorded using the RCR breast Group Classification U1-5 and M1-5

   d. All assessments should be carried out as part of triple assessment (i.e. clinical, imaging and needle biopsy) at the patients first visit

Target: 

1. 100%

2. 100%

3. 95%

Indicators: 

Percentage of patients managed according to the above recommendation.

Data items to be collected: 

Case notes and imaging records of patients presenting with clinical signs of breast disease; retrospective analysis.

Suggested number: 

100 consecutive symptomatic breast cases presenting to the outpatient or breast clinic.

• Create a standardised care pathway for patients attending the clinic

• Create a clear algorithm designed in such a way that all members of staff in the breast clinic can follow it easily

• Conduct regular, repeated, smaller audits to assess compliance

• Repeat date for commencing the next audit (following change): six months

• Identify staff member responsible for introducing change

- Audit clerk to retrieve medical and imaging records and to record the various stages of management and the type of imaging

- Consultant radiologist and surgeon to review the findings and prepare the report

- Between 10 and 20 hours for audit clerk to collate the data

- Three to five hours for the radiologist and surgeon to review the data and write up the report

1. Willett AM, MIchell MJ, Lee MJR (eds) Best practice guidelines for patients presenting with breast symptoms London Department of Health, 2010 https://associationofbreastsurgery.org.uk/media/1416/best-practice-diagnostic-guidelines-for-patients-presenting-with-breast-symptoms.pdf

    

Taken from Clinical Governance and Revalidation 2000 RCR, updated by K A Duncan & N Spence