NHSBSP Guidelines and use of VAE for B3 pathology saves money and reduces patient pathway
Association of Breast Surgery ePoster Library. Williams S. 05/15/17; 166200; P055
Susan Williams
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Abstract
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Introduction
B3 or indeterminate breast pathology combines a variety of heterogeneous pathological entities, with varying malignant potential and often cause a treatment dilemma. Recent NHSBSP guidelines help to delineate the treatment pathway following B3 diagnosis. Recommendations include for certain B3 pathology the use of second line Vacuum Assisted Excision(VAE), which decreases the need for open surgical biopsy. The aim of this audit was to assess current practice compared to guidelines and the potential cost saving from implementation.
Method
A 5 year audit of all B3 pathologies at Shrewsbury and Telford NHS Trust was performed from 2010 to 2015. Data was recorded from the Clinical Portal and included initial pathology, subsequent procedures, subsequent pathology, upgrade and downgrade rates. Cost saving analysis was performed to see how much would have been saved if the new NHSBSP guidelines had been followed.
Results
297 B3 pathologies were identified; repeat B3 biopsy and B4 pathology were excluded. Commonest initial B3 pathology was Papilloma or Papillary lesion without atypia 24%. 140 patients (47%) had excision as second line procedure. Upgrade rate was 22% and downgrade rate was 29%. Cost saving analysis showed that if VAE was available as a second line procedure, 115 patients (39%) could have had this instead of excision saving £80,960. In addition 10% of patients would have had reduced clinical pathway.
Conclusion
New guidelines recommend for selected B3 pathology, the use of VAE. This audit demonstrates not only does this save money but also reduces the steps in the patient's pathway.
B3 or indeterminate breast pathology combines a variety of heterogeneous pathological entities, with varying malignant potential and often cause a treatment dilemma. Recent NHSBSP guidelines help to delineate the treatment pathway following B3 diagnosis. Recommendations include for certain B3 pathology the use of second line Vacuum Assisted Excision(VAE), which decreases the need for open surgical biopsy. The aim of this audit was to assess current practice compared to guidelines and the potential cost saving from implementation.
Method
A 5 year audit of all B3 pathologies at Shrewsbury and Telford NHS Trust was performed from 2010 to 2015. Data was recorded from the Clinical Portal and included initial pathology, subsequent procedures, subsequent pathology, upgrade and downgrade rates. Cost saving analysis was performed to see how much would have been saved if the new NHSBSP guidelines had been followed.
Results
297 B3 pathologies were identified; repeat B3 biopsy and B4 pathology were excluded. Commonest initial B3 pathology was Papilloma or Papillary lesion without atypia 24%. 140 patients (47%) had excision as second line procedure. Upgrade rate was 22% and downgrade rate was 29%. Cost saving analysis showed that if VAE was available as a second line procedure, 115 patients (39%) could have had this instead of excision saving £80,960. In addition 10% of patients would have had reduced clinical pathway.
Conclusion
New guidelines recommend for selected B3 pathology, the use of VAE. This audit demonstrates not only does this save money but also reduces the steps in the patient's pathway.
Introduction
B3 or indeterminate breast pathology combines a variety of heterogeneous pathological entities, with varying malignant potential and often cause a treatment dilemma. Recent NHSBSP guidelines help to delineate the treatment pathway following B3 diagnosis. Recommendations include for certain B3 pathology the use of second line Vacuum Assisted Excision(VAE), which decreases the need for open surgical biopsy. The aim of this audit was to assess current practice compared to guidelines and the potential cost saving from implementation.
Method
A 5 year audit of all B3 pathologies at Shrewsbury and Telford NHS Trust was performed from 2010 to 2015. Data was recorded from the Clinical Portal and included initial pathology, subsequent procedures, subsequent pathology, upgrade and downgrade rates. Cost saving analysis was performed to see how much would have been saved if the new NHSBSP guidelines had been followed.
Results
297 B3 pathologies were identified; repeat B3 biopsy and B4 pathology were excluded. Commonest initial B3 pathology was Papilloma or Papillary lesion without atypia 24%. 140 patients (47%) had excision as second line procedure. Upgrade rate was 22% and downgrade rate was 29%. Cost saving analysis showed that if VAE was available as a second line procedure, 115 patients (39%) could have had this instead of excision saving £80,960. In addition 10% of patients would have had reduced clinical pathway.
Conclusion
New guidelines recommend for selected B3 pathology, the use of VAE. This audit demonstrates not only does this save money but also reduces the steps in the patient's pathway.
B3 or indeterminate breast pathology combines a variety of heterogeneous pathological entities, with varying malignant potential and often cause a treatment dilemma. Recent NHSBSP guidelines help to delineate the treatment pathway following B3 diagnosis. Recommendations include for certain B3 pathology the use of second line Vacuum Assisted Excision(VAE), which decreases the need for open surgical biopsy. The aim of this audit was to assess current practice compared to guidelines and the potential cost saving from implementation.
Method
A 5 year audit of all B3 pathologies at Shrewsbury and Telford NHS Trust was performed from 2010 to 2015. Data was recorded from the Clinical Portal and included initial pathology, subsequent procedures, subsequent pathology, upgrade and downgrade rates. Cost saving analysis was performed to see how much would have been saved if the new NHSBSP guidelines had been followed.
Results
297 B3 pathologies were identified; repeat B3 biopsy and B4 pathology were excluded. Commonest initial B3 pathology was Papilloma or Papillary lesion without atypia 24%. 140 patients (47%) had excision as second line procedure. Upgrade rate was 22% and downgrade rate was 29%. Cost saving analysis showed that if VAE was available as a second line procedure, 115 patients (39%) could have had this instead of excision saving £80,960. In addition 10% of patients would have had reduced clinical pathway.
Conclusion
New guidelines recommend for selected B3 pathology, the use of VAE. This audit demonstrates not only does this save money but also reduces the steps in the patient's pathway.
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