The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital
Amsterdam, Netherlands
Social Workers
Nutritional Counselling
Survivorship Groups
Sexual Health Counselling
Supportive and Palliative Care
Integrative Medicine
Radiology
Dedicated Radiologists8
Mammograms per year8000
Breast radiographers
Screening program
Verification for non-palpable breast lesions on specimen
Axillary US/US-guided FNAB
Clinical Research
Available imaging equipment
- Mammography
- Ultrasound
- Magnetic Resonance Imaging (MRI)
- tomosyntheses
Available work-up imaging equipment
- Computer Tomography
- Ultrasound
- Magnetic Resonance Imaging (MRI)
- PET/CT scan
- tomosyntheses
Primary technique for localizing non-palpable lesions
- Hook-wire (or needle localization)
- Charcoal marking/tattooing
- ROLL: radio-guided occult lesion localization
Available breast tissue sampling equipment
- Stereotactic Biopsy (Mammography guided)
- Core Biopsy (Tru-cut)
- Vacuum assisted biopsy
- Ultrasound-guided biopsy
- Fine-needle aspiration biopsy (FNAB, cytology)
- Core Biopsy
- Vacuum assisted biopsy
- MRI-guided biopsy
- Core Biopsy
- Vacuum assisted biopsy
Breast Surgery
New operated cases per year (benign and malignant) 750
Dedicated Breast Surgeons 5
Surgeons with more than 50 surgeries per year 5
Breast Surgery beds 20
Breast Nurse specialists 5
Outpatient surgery
Intra-operative evaluation of sentinel node
Reconstruction performed by Breast Surgeons
Clinical Research
Primary technique for staging the axilla
- Axillary lymph node dissection
- Sentinel lymph node biopsy:
- Blue dye technique
- Radio-tracer technique
- Blue dye + Radio-tracer
- Axillary sampling
- Sentinel node biopsy in primary surgery for cN0 and MARI procedure for cN1
Reconstructive/Plastic Surgery
Reconstructive/Plastic surgeons 6
Immediate Reconstruction available
Type of breast reconstructive surgery available
- Remodelling after breast-conserving surgery
- Reconstruction after mastectomy:
- Two-stage reconstruction (tissue expander followed by implant)
- One-stage reconstruction
- Autogenous tissue flap
- Latissimus dorsi flap
- Transverse rectus abdominis (TRAM)
- Free-flaps (free TRAM, DIEP, SIEA, gluteal, etc.)
- Surgery on the contralateral breast for symmetry
Pathology
Dedicated Breast Pathologists 4
Available studies
- Cytology
- Haematoxylin & eosin section (H&E)
- Surgical specimen
- Sentinel node
- Core biopsy
- Frozen section (FS)
- Surgical specimen
- Sentinel node
- Immunohistochemistry stain (IHC)
- Estrogen receptors
- Progesterone receptors
- HER-2
- Ki-67
Other special studies available
- Fluorescence in-situ Hybridization for HER-2 gene (FISH)
- Oncotype Dx (21-gene assay)
- MammaPrint (70-gene microarray)
- Prediction Analysis of Microarray 50-gene set (PAM 50)
Parameters included in the final pathology report
- Pathology stage (pT and pN)
- Tumour size (invasive component in mm)
- Histologic type
- Tumor grade
- ER/PR receptor status
- HER-2/neu receptor status
- Peritumoural/Lymphovascular invasion
- Margin status
- Ki-67, P-53, Androgen receptor
Medical Oncology
Dedicated Breast Medical Oncologists 5
Outpatient systemic therapy
Clinical Research
Radiotherapy
Dedicated Radiation Oncologists
Clinical Research
Available techniques after breast-conserving surgery (including experimental)
- Whole-Breast RT (WBRT)
- Partial breast irradiation (PBI):
- External beam PBI
- Interstitial brachytherapy
- Targeted brachytherapy (MammoSite, SAVI applicator, other devices)
- Intra-operative RT (IORT)
- breath hold incl. locoregional breath hold, IMRT, VMAT
Multidisciplinary Meeting (MDM) / Tumour Board (TB)
Regular MDM/TB for case management discussion
- Twice a week
- Weekly
- Every two weeks
- Other Schedule
Cases discussed at MDM/TB
- Preoperative cases
- Postoperative cases
Specialties/services participating in MDM/TB
- Radiology
- Breast Surgery
- Reconstructive/Plastic Surgery
- Pathology
- Medical Oncology
- Radiotherapy
- Genetic Counselling
- Breast Nurse Service
- Psycho-oncology
- research physicians, research nurses
Further Services and Facilities
Nuclear Medicine
- Lymphoscintigraphy
- Bone scan
- Positron Emission Tomography (PET)
- PET/CT scan
- dedicated -mammai- PET, Spect CT scanning, Sentinella probes
Rehabilitation
- Prosthesis service
- Physiotherapy
- Lymph-oedema treatment
Genetic Counselling
- Specialist Providing Genetic Counselling/Risk assessment service:
- Dedicated Clinical Geneticist
- Medical Oncologist
- Breast Surgeon
- General Surgeon
- Gynaecologist
- Genetic Testing available
- Surveillance program for high-risk women
Data Management
- Database used for clinical information
- Data manager available
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