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Eur J Cancer. 2016 Oct;66:131-7. doi: 10.1016/j.ejca.2016.06.021. Epub 2016 Aug 26.

The challenge of rapid diagnosis in oncology: Diagnostic accuracy and cost analysis of a large-scale one-stop breast clinic.

Author information

1
Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France. Electronic address: suzette.delaloge@gustaveroussy.fr.
2
Gustave Roussy, Université Paris-Saclay, Department of Biostatistics, Epidemiology and Health Economics, Villejuif, F-94805, France; INSERM U1018, CESP Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Université Paris-Saclay, Villejuif, France.
3
Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France.
4
Gustave Roussy, Université Paris-Saclay, Department of Supportive Care, Villejuif, F-94805, France.
5
Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France.
6
Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France.
7
Gustave Roussy, Université Paris-Saclay, Department of Radiation Therapy, Villejuif, F-94805, France.
8
Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France.
9
Gustave Roussy, Université Paris-Saclay, Department of Medical Information, Villejuif, F-94805, France.

Abstract

PURPOSE:

Rapid diagnosis is a key issue in modern oncology, for which one-stop breast clinics are a model. We aimed to assess the diagnosis accuracy and procedure costs of a large-scale one-stop breast clinic.

PATIENTS AND METHODS:

A total of 10,602 individuals with suspect breast lesions attended the Gustave Roussy's regional one-stop breast clinic between 2004 and 2012. The multidisciplinary clinic uses multimodal imaging together with ultrasonography-guided fine needle aspiration for masses and ultrasonography-guided and stereotactic biopsies as needed. Diagnostic accuracy was assessed by comparing one-stop diagnosis to the consolidated diagnosis obtained after surgery or biopsy or long-term monitoring. The medical cost per patient of the care pathway was assessed from patient-level data collected prospectively.

RESULTS:

Sixty-nine percent of the patients had masses, while 31% had micro-calcifications or other non-mass lesions. In 75% of the cases (87% of masses), an exact diagnosis could be given on the same day. In the base-case analysis (i.e. considering only benign and malignant lesions at one-stop and at consolidated diagnoses), the sensitivity of the one-stop clinic was 98.4%, specificity 99.8%, positive and negative predictive values 99.7% and 99.0%. In the sensitivity analysis (reclassification of suspect, atypical and undetermined lesions), diagnostic sensitivity varied from 90.3% to 98.5% and specificity varied from 94.3% to 99.8%. The mean medical cost per patient of one-stop diagnostic procedure was €420.

CONCLUSIONS:

One-stop breast clinic can provide timely and cost-efficient delivery of highly accurate diagnoses and serve as models of care for multiple settings, including rapid screening-linked diagnosis.

KEYWORDS:

Breast cancer; Cost analysis; Diagnosis; One-stop clinic; Sensitivity; Specificity

PMID:
27569041
DOI:
10.1016/j.ejca.2016.06.021
[Indexed for MEDLINE]

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