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

• Published in: European journal of cancer (1990) 2016-10, Vol.66, p.131-137
• Main Authors: Delaloge, Suzette, Bonastre, Julia, Borget, Isabelle, Garbay, Jean-Rémi, Fontenay, Rachel, Boinon, Diane, Saghatchian, Mahasti, Mathieu, Marie-Christine, Mazouni, Chafika, Rivera, Sofia, Uzan, Catherine, André, Fabrice, Dromain, Clarisse, Boyer, Bruno, Pistilli, Barbara, Azoulay, Sandy, Rimareix, Françoise, Bayou, El-Hadi, Sarfati, Benjamin, Caron, Hélène, Ghouadni, Amal, Leymarie, Nicolas, Canale, Sandra, Mons, Muriel, Arfi-Rouche, Julia, Arnedos, Monica, Suciu, Voichita, Vielh, Philippe, Balleyguier, Corinne
• Format: Article
• Language: English
• Subjects: Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - economics; Breast Neoplasms, Male - diagnosis; Breast Neoplasms, Male - economics; Cancer Care Facilities - economics; Cancer Care Facilities - standards; Cost analysis; Costs and Cost Analysis; Diagnosis; Early Detection of Cancer - economics; Early Detection of Cancer - standards; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Feasibility Studies; Female; Hematology, Oncology and Palliative Medicine; Humans; Male; Middle Aged; One-stop clinic; Point-of-Care Systems - economics; Point-of-Care Systems - standards; Prospective Studies; Sensitivity; Sensitivity and Specificity; Specificity
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2016.06.021

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.