Meme muayenesi yaptıran hastalara yaklaşım ve işbirliğinin değerlendirilmesinde multidisipliner farklılıklar

Öz

Amaç: Bu çalışmanın amacı meme muayenesi için hastaneye başvuran hastaların polikliniklerini ve bu uygulamalar sonrasındaki tanı sürecini incelemektir. İkincil amacı da meme kanseri tanısı için genel cerrahi (GC) poliklinikleri ile diğer genel cerrahi dışı kliniklerin karşılaştırılmasıdır. Gereç ve Yöntemler: Hastanemizin 1 Ocak 2015-15 Haziran 2019 tarihleri arasında genel cerrahi(GC), Dahiliye (IM), Kadın Hastalıkları ve Doğum (OG) polikliniklerine başvuran hastalar retrospektif olarak incelendi. Sürekli değişkenler ortalama ve standart sapma olarak rapor edilirken, kategorik nominal değişkenler toplam popülasyonun yüzdesi olarak ifade edildi. Bulgular: 1 Ocak 2015-15 Haziran 2019 tarihleri arasında meme muayenesi için gerekli olan toplam mamografi sayısı 7998'dir. Bunların 1769'u Gc, 456'sı IM ve 5773'ü OG poliklinikleridir. Yaş ortalaması Gc'de 48±2,3, IM'de 48±6,7, OG polikliniklerinde 47±3,9 idi (p>0,05). Malign meme vaka sayılarının dağılımı sırasıyla GC: 43, OG: 21, IM: 5 şeklindedir. Toplamda 69 meme kanseri teşhisi konulmuştur. Klinik hakimiyet açısından genel cerrahi kliniği meme kanseri koymada en etkili klinik olarak ortaya çıkmıştır [AOR: 0,34 (0,2-0,54) (P <0,001)]. Mamografi BIRADS 4 ve 5 olan hastalarda malignite riski BIRADS 0-1-2-3 olanlara göre daha yüksekti [AOR: 0,81 (0,72-0,9) (P <0,001)]. Sonuç: Özellikle maligniteyi ilgilendiren meme hastalıklarının tanısında en önemli mihenk taşının klinikler arası işbirliği ile yapılan fizik muayene, anamnez ve görüntüleme teknikleri olduğuna inanıyoruz.

Anahtar Kelimeler

• Meme kanseri
• fizik muayene
• klinikler arası işbirliği

Multidisciplinary Differences in Approaches to Patients Undergoing Breast Examination and Evaluation of Collaborations

Öz

Objective: The purpose of this study is to examine the outpatient clinics of patients admitted to the hospital for breast examinations and the diagnostic process after these applications. It also compares the results of the examination and diagnosis with the results of the general surgery (GS) outpatient clinic, especially after admission to non-general surgery clinics. Materials and Methods: The patients who came to the GS, internal medicine (IM), and obstetrics and gynecology (OG) outpatient clinics of our hospital between January 1, 2015, and June 15, 2019, were examined retrospectively. Continuous variables were reported as the mean and standard deviation, whereas categorical nominal variables were expressed as a percentage of the total population. Results:Between January 1,2015, and June 15,2019, the total number of mammograms required for breast examination was 7998. Of these, 1769 were GS, 456 were IM, and 5773 of them were OG outpatient clinics.The mean age was 48±2.3 years in GS, 48±6.7 years in IM, and 47±3.9 years in OG outpatient clinics(p >0.05).Breast Imaging Reporting and Data System(BI-RADS) distributions of mammography cases of patients admitted to the GS outpatient clinic were: BIRADS 5: 35,BIRADS 4: 15,BIRADS 3: 328,BIRADS 2: 14,BIRADS 1: 2, and BIRADS 0: 1375.BIRADS distributions of mammography of patients admitted to the OG outpatient clinic were:BIRADS 5; 10,BIRADS 4: 36,BIRADS 3: 558,BIRADS 2: 1365,BIRADS 1: 1424, and BIRADS 0: 2380.BIRADS distributions of mammography cases of patients admitted to the IM outpatient clinic were: BIRADS 5; 4, BIRADS 4: 3, BIRADS 3: 37, BIRADS 2: 111, BIRADS 1: 124, and BIRADS 0:177.A total of 15 patients with BIRADS 4 and 5, and 3 patients with BIRADS 3 were referred to the GS outpatient clinic.Malignancy was diagnosed in 21 of them.On the other hand, BIRADS 4 and BIRADS 5 were referred from the IM outpatient clinic to the GS outpatient clinic for a total of seven patients.Then, five of these seven patients were diagnosed with breast cancer.In total, 69 breast cancer diagnoses were made thanks to collaboration with GS, OG, and IM outpatient clinics. Conclusion:We believe that the first use of physical examination, anamnesis, and imaging techniques in combination with the diagnosis of breast diseases, especially concerning malignancy, will reduce the cases of missed malignancy.In addition, because of sociocultural factors, patients who come to other branches expect the doctor to ask for breast examinations, but breast examination remains incomplete.Also, since GS is the main branch regarding breast diseases, we think that other branches should be coordinated with GS.

Anahtar Kelimeler

• breast
• cancer
• clinical examination
• interclinical collaboration

Kaynakça

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