Demonstration of an expedited breast care (EBC) clinic

Abstract

16023 Background: Women report waiting for a breast biopsy result as a time of psychological distress. Waiting also delays entry into definitive oncology care, and patients in underserved communities may be lost to follow up. In this proof-of-concept demonstration, an Expedited Breast Care (EBC) clinic was developed to give patients the opportunity to receive same-day biopsy results. Methods: Patients requiring core breast biopsy at a community hospital were approached sequentially to participate. Following surgical biopsy, tissue underwent ultra-rapid fixation and processing. After paraffin sections were prepared and stained, the glass histopathology slides were imaged with a virtual slide scanner. Digital images were stored on a server and viewed on the Internet by a telepathologist at a tertiary care center. Light microscopy review was concurrently performed as the gold standard. After telepathology review and light microscopy confirmation, patients presented to the telemedicine suite to receive biopsy results. A teleoncologist at the tertiary care center presented all pathology results to the patient, whether benign or malignant. Time and patient satisfaction data were collected. Results: Nine patients have participated. Within 2 hours from the time the tissue arrived at the laboratory, digital images were available to the telepathologist. The teleoncologist presented results to patients within 3–5 hours after the biopsy procedure. Patients reported satisfaction with the same-day service, and stated they would seek EBC again in the event of a future breast biopsy. Many patients expressed relief at receiving results so promptly and felt they had avoided the stress of waiting longer for results. The elapsed time from mammogram to definitive oncology care was shorter for EBC patients compared to a control group of patients at a clinic not offering EBC, although the results did not reach statistical significance (Mann-Whitney U: Z = −1.804, p = 0.0713). Conclusions: These data indicate EBC can be successfully accomplished. Current studies to assess EBC’s role in facilitating prompt entry into definitive oncology care are underway. By incorporating rapid tissue processing with telepathology and teleoncology, EBC can improve access to breast care in underserved areas. [Table: see text]