Cochrane R A, Singhal H, Monypenny I J, Webster D J, Lyons K, Mansel R E
Department of Academic Surgery, University Hospital of Wales, Cardiff, South Glamorgan, UK.
Eur J Surg Oncol. 1997 Jun;23(3):198-201. doi: 10.1016/s0748-7983(97)92220-4.
The recently published national guidelines to general practitioners for the referral of patients with breast problems were retrospectively applied to letters of all patients attending the Rapid Access Breast Clinic at the University Hospital of Wales. The patients have all had diagnostic investigations performed at the initial visit with a multidisciplinary review of results and provision of a management plan prior to the subsequent visit. Since its inception in May 1995 until the end of the year when the guidelines were published, 2332 new patients had been seen. Overall, 29% of patients with benign breast disease would not have been referred if the guidelines had been strictly followed. Of the 147 symptomatic carcinomas diagnosed from general practitioner referrals (6.3% of total referrals), no invasive cancers would have been missed. One patient with incidental detection of ductal carcinoma in situ (DCIS) in the asymptomatic contralateral breast would not have been referred. Referral for pain without a discrete lump constituted 63% of the patients with a benign diagnosis who fell outside the guidelines. The guidelines also include comprehensive algorithms for the initial management of benign breast symptoms that do not require immediate referral by the general practitioners. Our general practitioners were significantly better at referring patients over 50 years old but the proportion of appropriate referrals were not related to the number referred by each practice. The present guidelines adequately cover referral for the diagnosis of malignant breast disease to a specialist, and may reduce the benign workload of breast clinics.
最近发布的针对全科医生转诊乳腺问题患者的国家指南被回顾性应用于威尔士大学医院快速通道乳腺诊所所有就诊患者的信件。所有患者在初次就诊时都进行了诊断性检查，并在后续就诊前对检查结果进行了多学科评估并提供了管理计划。自1995年5月成立至该指南发布的当年年底，共诊治了2332名新患者。总体而言，如果严格遵循指南，29%的乳腺良性疾病患者不会被转诊。在从全科医生转诊中诊断出的147例有症状的癌症中（占总转诊数的6.3%），没有漏诊任何浸润性癌症。一名在无症状的对侧乳房中偶然发现导管原位癌（DCIS）的患者不会被转诊。因疼痛而无明确肿块的转诊患者占不符合指南的良性诊断患者的63%。该指南还包括针对乳腺良性症状初始管理的综合算法，这些症状不需要全科医生立即转诊。我们全科医生在转诊50岁以上患者方面做得明显更好，但适当转诊的比例与每个诊所转诊的数量无关。目前的指南充分涵盖了将乳腺恶性疾病诊断转诊给专科医生的情况，并可能减少乳腺诊所的良性工作量。
