On October 2, 2019, fifteen physicians from several departments at the Vernon Jubilee Hospital (VJH), met to discuss Fine Wire Localization.
Eight cases of oncoplastic breast cancer surgery at VJH were presented employing fine wire localization.
An issue was raised with the margin marker kit, and the conclusion was to adopt the lab standard with a clearly marked colour poster placed in OR 1.
Challenges with wire placement and surgery were addressed by suggesting surgeon and procedural radiologist to discuss each case in advance to eliminate miscommunication and that the procedural radiology be listed on the OR slate.
The pan Canadian standards for breast cancer surgery document was reviewed. Reference: https://s22457.pcdn.co/wp-content/uploads/2019/05/Breast-Cancer-Surgery- Standards-EN-April-2019.pdf
Issues with delays in diagnosis due to patients having to come multiple times because biopsy wasn’t done on the first imaging visit were addressed by suggesting the breast imaging requisition to allow for automatic recall or immediate biopsy of suspicious lesions (Birads 4-5) and that protocol be implemented to automatically biopsy all suspicious lesions without waiting for a second requisition.
Issues with referrals to surgery after one failed image biopsy were addressed by suggesting that surgical biopsy for diagnosis should only be done after at least two attempts made, if technically possible.
Concordance statements on all image guided breast biopsies were recommended.
Automatic recall for re-biopsy was recommended in the case of a discordant result of suspicious lesion with benign pathology without needed new requisition.
The turnaround for receptor results has room for improvement at VJH. At the present, turnaround is up to four weeks, and efforts are underway to come more closely in line with Vancouver’s turnaround which is three to four days. Currently, the tests are sent to Vancouver but have been done in Kelowna in the early 2000s. Because of the importance of decision making, particularly in young patients who are triple negative or HER2 positive and may need neoadjuvant chemo, the receptor results need to be available within seven days of the biopsy.
It was suggested to have a follow up meeting in six months to see if there are improvements in turn around timelines.