The integration of diagnostic tests and the role of outpatient surgery in the management of breast disease.

The aim of the earliest possible diagnosis of breast carcinoma achieved through the integration of clinical, mammographic, sonographic and cytologic data has determined an increased detection of breast lesions and a greater accuracy in their description. Nevertheless, the nature of some of these lesions cannot be well-defined because of their biological characteristics and their physical, radiological or cytological aspects. The need to obtain a definitive diagnosis in any case has given rise to a paradoxical increase in histologic examinations: in specific conditions and for certain kinds of lesions, outpatient surgery under local anesthesia could very well represent a supplementary tool in the diagnostic and therapeutic strategy for the management of breast lesions. The data here reported concern 397 breast lesions for which it was thought appropriate to complete the diagnostic procedure with the surgical excision on an outpatient basis under local anesthesia. Excluding the 3 breast lymphomas and the 19 loco-regional recurrences, for which the purpose of outpatient surgery was therapeutic, at the histologic examination 35% benign lesions, of which 91 associated with an increased risk of breast cancer, were found, as well as 11 in situ and 10 invasive carcinomas (false negatives), with a therapeutic option error of 2.5%. Now that one of the principal aims of public management is to put a check on health expenditures, outpatient surgery would contribute to obtaining the correct balance between proper management of breast lesions and low cost/effective ratio.