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SYNERGY AMONG BREAST UNITS

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Military Medical Academy Sofia

Sofia, Bulgaria

available Social Workers

available Nutritional Counselling

available Survivorship Groups

available Sexual Health Counselling

available Supportive and Palliative Care

available Integrative Medicine

Radiology

availableDedicated Radiologists2

Mammograms per year2000

availableBreast radiographers

availableScreening program

not availableVerification for non-palpable breast lesions on specimen

availableAxillary US/US-guided FNAB

availableClinical Research

Available imaging equipment

  • availableMammography
  • availableUltrasound
  • availableMagnetic Resonance Imaging (MRI)

Available work-up imaging equipment

  • availableComputer Tomography
  • availableUltrasound
  • availableMagnetic Resonance Imaging (MRI)
  • not availablePET/CT scan
  • availableRadioisotopic Bone Scintigraphy with the Gamma Camera

Primary technique for localizing non-palpable lesions

  • not availableHook-wire (or needle localization)
  • not availableCharcoal marking/tattooing
  • availableROLL: radio-guided occult lesion localization

Available breast tissue sampling equipment

  • not availableStereotactic Biopsy (Mammography guided)
    • not availableCore Biopsy (Tru-cut)
    • not availableVacuum assisted biopsy
  • availableUltrasound-guided biopsy
    • availableFine-needle aspiration biopsy (FNAB, cytology)
    • availableCore Biopsy
    • not availableVacuum assisted biopsy
  • availableMRI-guided biopsy
    • availableCore Biopsy
    • not availableVacuum assisted biopsy

Breast Surgery

availableNew operated cases per year (benign and malignant)  522

availableDedicated Breast Surgeons  2

availableSurgeons with more than 50 surgeries per year  2

availableBreast Surgery beds  22

availableBreast Nurse specialists  2

availableOutpatient surgery

availableIntra-operative evaluation of sentinel node

availableReconstruction performed by Breast Surgeons

availableClinical Research

Primary technique for staging the axilla

  • availableAxillary lymph node dissection
  • not availableSentinel lymph node biopsy:
    • not availableBlue dye technique
    • not availableRadio-tracer technique
    • not availableBlue dye + Radio-tracer
  • not availableAxillary sampling

Reconstructive/Plastic Surgery

availableReconstructive/Plastic surgeons  2

availableImmediate Reconstruction available

Type of breast reconstructive surgery available

  • not availableRemodelling after breast-conserving surgery
  • availableReconstruction after mastectomy:
    • availableTwo-stage reconstruction (tissue expander followed by implant)
    • availableOne-stage reconstruction
    • availableAutogenous tissue flap
      • availableLatissimus dorsi flap
      • availableTransverse rectus abdominis (TRAM)
      • availableFree-flaps (free TRAM, DIEP, SIEA, gluteal, etc.)
  • availableSurgery on the contralateral breast for symmetry

Pathology

availableDedicated Breast Pathologists  2

Available studies

  • availableCytology
  • availableHaematoxylin & eosin section (H&E)
    • availableSurgical specimen
    • availableSentinel node
    • availableCore biopsy
  • availableFrozen section (FS)
    • availableSurgical specimen
    • availableSentinel node
  • availableImmunohistochemistry stain (IHC)
    • availableEstrogen receptors
    • availableProgesterone receptors
    • availableHER-2
    • availableKi-67

Other special studies available

  • availableFluorescence in-situ Hybridization for HER-2 gene (FISH)
  • not availableOncotype Dx (21-gene assay)
  • not availableMammaPrint (70-gene microarray)
  • not availablePrediction Analysis of Microarray 50-gene set (PAM 50)

Parameters included in the final pathology report

  • availablePathology stage (pT and pN)
  • availableTumour size (invasive component in mm)
  • availableHistologic type
  • availableTumor grade
  • availableER/PR receptor status
  • availableHER-2/neu receptor status
  • availablePeritumoural/Lymphovascular invasion
  • availableMargin status

Medical Oncology

availableDedicated Breast Medical Oncologists  1

availableOutpatient systemic therapy

availableClinical Research

Radiotherapy

availableDedicated Radiation Oncologists

not availableClinical Research

Available techniques after breast-conserving surgery (including experimental)

  • availableWhole-Breast RT (WBRT)
  • availablePartial breast irradiation (PBI):
    • availableExternal beam PBI
    • availableInterstitial brachytherapy
    • availableTargeted brachytherapy (MammoSite, SAVI applicator, other devices)
    • not availableIntra-operative RT (IORT)

Multidisciplinary Meeting (MDM) / Tumour Board (TB)

Regular MDM/TB for case management discussion

  • availableTwice a week
  • not availableWeekly
  • not availableEvery two weeks
  • not availableOther Schedule

Cases discussed at MDM/TB

  • available Preoperative cases
  • available Postoperative cases

Specialties/services participating in MDM/TB

  • availableRadiology
  • availableBreast Surgery
  • availableReconstructive/Plastic Surgery
  • availablePathology
  • availableMedical Oncology
  • availableRadiotherapy
  • availableGenetic Counselling
  • availableBreast Nurse Service
  • availablePsycho-oncology

Further Services and Facilities

Nuclear Medicine

  • availableLymphoscintigraphy
  • availableBone scan
  • availablePositron Emission Tomography (PET)
  • availablePET/CT scan

Rehabilitation

  • availableProsthesis service
  • availablePhysiotherapy
  • availableLymph-oedema treatment

Genetic Counselling

  • availableSpecialist Providing Genetic Counselling/Risk assessment service:
    • availableDedicated Clinical Geneticist
    • not availableMedical Oncologist
    • not availableBreast Surgeon
    • not availableGeneral Surgeon
    • not availableGynaecologist
  • availableGenetic Testing available
  • availableSurveillance program for high-risk women

Data Management

  • availableDatabase used for clinical information
  • availableData manager available

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