Analysis of surgical and diagnostic quality at a specialist breast unit

The quality of a specialist breast unit was analysed prospectively, comparing data from 1998, with data from 2003. The analysis is based on 5451 new referrals and 632 major breast cancer operations. The period was characterized by an increasing number of surgical specialists and improvements in diagnostic resources. There was statistically significant improvement in the following parameters: frequency of excision biopsies fell from 17.3% to 10.4%; preoperative cancer diagnosis without excision biopsy rose from 67.4% to 95.1%; percentage of women receiving breast conserving surgery rose from 24.4% to 44.7%. Cases where less than 10 lymph nodes were removed at axillary dissection fell from 5.8% to 0.5%. Severe postoperative bleeding fell from 4.1% to 0.8%, severe wound infection from 4.7% to 1.1% and severe skin necrosis from 3.7% to 0.2%. It is concluded that centralization of surgical and diagnostic expertise at a high volume institution contributes positively to the quality of care.