Page 5 - ABUS-Casestudy

Prof. Erkin Aribal, MD At a glance

Practice setting – Multidisciplinary breast department in private chain hospital
Head of Multidisciplinary
Breast Department Department staffing – 4 radiologists, 5 technicians, 1 receptionist, 1 patient navigator,
Acibadem Altunizade Hospital 1 patient coordinator
Istanbul, Turkey Modalities – HHUS, ABUS, DBT, CSM, MRI (in radiology)
Patient volume – 5,000 patients per year 90% screening 10% diagnostic
Coverage / reimbursement – Government funded in public centers / out of pocket in
private centers
Country guideline – Government screening program – biannual screening
mammogram for women 40-69
Risk stratification – Gail for low risk women; Tyrer-Cuzick for dense breasts / family history

The site
Prof. Erkin Aribal, MD is Head of the Multidisciplinary Breast Department at the Acibadem “ We have a very full schedule,
Altunizade Hospital in Istanbul, Turkey. The department architecture is designed in a way to ensure so we need a smooth patient
patient comfort and privacy. Examination, diagnosis, and treatment are planned and practiced process. ABUS helps achieve a
in featured units, which involved a multidisciplinary team including surgeon, radiologist and more efficient workflow, it saves
oncologist to ensure precise and fast diagnosis and treatment for breast cancer patient.
radiologist time and gives us
Care pathway for patients with dense breasts the chance to focus more on the
patients and her symptoms
Risk assessment is performed for all patients coming into the multidisciplinary breast
department at the Acibadem Altunizade Hospital clinic, using the Gail model for low risk women or findings.”
and Tyrer-Cuzick for women with a family history and/or dense breasts. The clinic performs
digital breast tomosynthesis (DBT), contrast enhanced mammography (CEM), automated breast “ ABUS is a fundamental
ultrasound (ABUS), hand-held ultrasound (HHUS) and breast MRI. examination for diagnostic
patients. It is a very useful
In Turkey, the limitations of mammography in women with dense breasts are well known.
As a result, supplemental ultrasound is routinely offered in conjunction with mammography complementary tool to
screening, regardless of breast density. The clinic uses ABUS as the first supplemental screening mammography, and since it is
method after DBT or 2D Mammography. The use of Breast MR is also growing with effectiveness 3D volume imaging, it is very
studies and widespread access to Breast MR in Turkey. Contrast Enhanced Mammography is less comparable to Breast MR for
frequently used, particularly in patients where an alternative method to Breast MRI is needed. surgical planning and ongoing
diagnostic monitoring.”
Screening Risk stratification
decision tree and personal history Diagnostic ABUS
in breast clinic
In diagnostics, ABUS is used if the patient
is younger than 40, followed by focused
HHUS and DBT depending on the ABUS
findings. DBT is used first if the patient
is over 40, followed by ABUS and HHUS
for findings. For further evaluation of
suspicious lesions and disease extent,
Breast MR is used.
Screening 2D FFDM/DBT and ABUS for all patients Focused HHUS if findings
ABUS is also used as a second look MRI
for patients with positive finding on MRI.
MRI recommended every 2-3 years for
dense breast (BI-RADS D) and alternating
protocols for high risk patients. Walk in the shoes of a
*
breast care patient in a
multimodality breast
* Annual DBT and MRI for very high risk patients (BRCA positive),
with ABUS every 6 months imaging centre