Evaluación de una unidad de patología mamaria en la atención primaria

Abstract

The aim of this work is to evaluate the evolution and development of an imaging unit in a primary care centre and to define the role of the radiologist in the team.<br/>Methods and material. Between 1985 and 2004 116.726 patients were studied, of whom 912 were male.<br/>Results and discussion. There are two basic factors for a good functioning of an imaging unit: a dedicated full time radiologist and a reference centre.<br/>A full time radiologist increases markedly the productivity. In our study it increased since her arrival to more than eight thousand patients a year, keeping steady since. The quality also increased: the number of misplaced previous studies decreased from 10% to 4%; unnecessary or poorly indicated studies were eliminated and a fast diagnostic path was established in collaboration with the reference centre.<br/>The three most common indicators of quality are: the rate of detection of carcinoma per thousand women, the rate of benign to malignant biopsies and the percentage of ultrasound studies.<br/>Rate of detection should not be lower than two per thousand. In our results, it varies between 2 and 5.5, with a mean of 3.3. In symptomatic patients should be superior to 10 per thousand. In our results, it varies between 15,9 and 24,79 with a mean of 22.6.<br/>The percentage of benign vs. malignant biopsies should be between 25 and 40%. Our percentage is 48,6. The percentage of ultrasound studies in screening should not be over 10%. In our study it rises to 15%. We believe it is due to the fact that we run a mixed practice, with screening and symptomatic patients. <br/>In a primary care centre, the radiologist acts as consultant to the referring physicians due to their geographic dispersion. The radiologist is the liaison with the reference centre and keeps the files for consultation of the referring physicians.<br/>A reference centre is basic for consultation and realization of additional procedures (MRI, core biopsy), not available in the primary care centre. In our experience, only 2% of women need to be sent to the reference centre, which avoid collapsing it.<br/>In primary care there are processes that do not arrive to large hospitals, such as pathology in women less than 25 years old, and breast pathology in men.<br/>Primary care is not incompatible with scientific production. Communications and exhibits to national and international meetings have been presented.