Abstract
Consultant radiologists are still deeply divided in their opinions about advanced practice, many still having concerns about clinical governance and the training and supervision needed. I have used a small questionnaire to obtain a 'snapshot' of breast screening units who use radiographer advanced practitioners, what they do, whether they replace or just augment the functions of a consultant radiologist, and the opinions of the radiologists working alongside them. Advanced practice means more than just a means to enable second reading of films. Without continuous feedback, involvement in assessment and support, this can become a boring task, with skill levels and motivation difficult to sustain. Increasingly, in many units practitioners are replacing other aspects of the traditional role of the consultant radiologist. Almost all advanced practitioners are film readers, but many have extended their roles further and now also do stereo tactic biopsy, ultrasound and ultrasound-guided biopsy, clinical examination, and localisation of impalpable tumours. We need to encourage the many eligible units who could participate in the current trial of radiographer-only screen film reading to join, in order to provide concrete evidence that radiographers are as good as radiologists in real-life practice. With consultant radiologist posts becoming a little easier to fill than previously, we need to examine this role more carefully and decide what benefits practitioners can bring to a unit, and how to make this role a fulfilling and secure one for our radiographers in the future.
Highlights
Axillary lymph node dissection has been standard practice for staging invasive breast cancer
Best estimates for where to credit this dramatic drop in death rate place approximately 50% of the credit with improved adjuvant chemotherapy and 50% with mammography
Full field digital mammography (FFDM) had a higher detection rate for ductal carcinoma in situ (DCIS) but no difference was observed for invasive tumours
Summary
Axillary lymph node dissection has been standard practice for staging invasive breast cancer. Aim To assess the feasibility of surgeons performing breast US in symptomatic breast clinics either as an adjunct to triple assessment or on their own for diagnostic and therapeutic purposes. The performance of individual units is monitored to ensure all women have access to an excellent service Aim This project aims to demonstrate how the Liverpool Breast Unit addressed failure to meet the national quality standard for the benign. Method A retrospective review of the records of patients who had undergone benign biopsy (2001–2002) was conducted to establish reasons for surgical referral and suggest corrective measures to enable the unit to meet the standard in the future. Columnar cell change (CCC) is diagnosed on core biopsies performed for indeterminate microcalcification. Method Mammograms of 33 cases with established CCC on core biopsy were reviewed and the radiological features, follow-up imaging and surgical excision histology (if performed) were collated. The results were completed when all units were undergoing assimilation onto the new banding procedures
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