Estimated GFR (and creatinine) values in patients with renal insufficiency did not show a statistically significant increase after a mean of 3.5 days of receiving intravenous contrast and therefore supports a conservative outpatient-based management approach.
High mammographic breast density can be used as one of the selection criteria for pre-operative MRI in ILC without an increase in inappropriate mastectomies with potential time and cost savings. In this cohort, re-excisions were not reduced markedly with pre-operative MRI.
Background
COVID-19 infection led to a substantial overhaul of the symptomatic breast services within the UK.
Aim
The purpose of this study was to evaluate the pattern of primary care referrals to the symptomatic one-stop clinic during the pandemic. This study also provides a snapshot of the workings of symptomatic breast services and the scope for improvements.
Methods
The data points were collected for 1 month during the peak of the pandemic (April 2020) and compared to corresponding data points for the same month in the previous year (April 2019). This was compared to the monthly data from Wales Cancer Network (WCN) data source. A hundred patients from each month over 2 years were evaluated to get a snapshot into the working of the breast clinic.
Results
A total of 516 patients were referred from primary care or General Practitioners (GPs), and were seen in the Hospital ‘one-stop breast clinic’ in April 2019. This number dropped to 330 patients during the peak of the pandemic in April 2020. Ninety percent of referrals from the GP were urgent suspected cancers or urgent referrals. This trend of referrals did not change over 2 years. There was a 5% and 7% cancer diagnosis rate in 2020 and 2019, respectively.
Conclusions
Most patients were referred from GP as ‘urgent’ or ‘urgent suspected cancer’. The cancer diagnosis rate reduced from 7 to 5% during the pandemic peak but the number of ‘worried well’ patients did not reduce. The total number of referrals reduced, which is predictive of increased demand in the future. The authors have suggested ways to meet this demand.
Radiologists play a pivotal role in patient management in modern hospital medicine and more so with regard to breast imaging. The diagnosis of breast pathology hinges predominantly on mammography and ultrasound imaging. With reduced clinician confidence in clinical examination alone, virtually all patients with breast symptoms are being referred for imaging. The traditional ‘one-stop’ clinics are victims of their own success and demand outstrips availability. This article makes a case for imaging-led breast clinics to increase efficiency, reduce duplication of work and cost, and increase throughput of patients.
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