Information For GP's

Process for referral
The Private Breast Clinic Cork operates on:
Tuesday 2:30 - 5:30 p.m.
Wednesday 2:30 - 5:30 p.m.
Friday 2:30 - 5:30 p.m.
To book an appointment, please call Telephone: (021) 4941367
In case of acute complaints or emergency cases please contact us directly by Telephone: (021) 4941367
To refer for diagnostic imaging without clini cal assessment please download this online request form (hyperlink)
Fax: 021 494 1366
For urgent imaging please call: 021 49 41361
Process of assessment
The aim of this information is to give the general practitioner insight into the examinations and procedures which any patient attending the Symptomatic Breast Imaging Unit may have to undergo.
After having had a clinical breast examination the patient is referred to the Breast Imaging Unit. The diagnostic imaging available includes:
• Mammogram
• Ultrasound
Whilst not all patients require multimodality assessment more complex cases not uncommonly require several tests to reach complete and accurate diagnosis.
A standard mammogram and ultrasound often lead to may lead to other breast Imaging Diagnostic tests such as
• Further mammographic views to characterize masses and calcifications including
• Spot Compression Views
• Magnification Views
• Biopsy which includes
• Ultrasound Guided Biopsy
• Stereotactic Guided Biopsy
• Wire Localisation
•Fine needle aspiration and cytology
•    Magnetic Resonance Imaging (MRI)
Results
Radiology and pathology reports will be available (faxed) in 48 hours to the referring clinician
Please contact X for urgent reports or queries
Mammogram Reports 
The system used to grade is mammography report is the R Score/category system. A similar score is also used for the clinical assessment (S score) and pathological biopsy review (B score).  The combination of scores is discussed in the multidisciplinary setting.
Category 1: Negative 
In this case, there is no significant abnormality to report. The breasts look the same (they are symmetrical) with no masses, distorted structures, or suspicious calcifications. 
Category 2: Benign (non-cancerous) finding 
This is also a negative mammogram result, but the reporting doctor chooses to describe a finding known to be benign, such as benign calcifications, intra-mammary lymph nodes, or calcified fibroadenomas. This ensures that others who look at the mammogram will not misinterpret this benign finding as suspicious. 
Category 3: Probably benign finding 
The findings in this category have a very good chance (greater than 98%) of being benign (not cancer). The findings are not expected to change over time. Often these lesions are biopsied to prove they are benign, particularly if there is a new symptom and/or no previous mammogram.
Category 4: Suspicious abnormality -- Biopsy should be considered 
; top: 0px; left: -10000px;">Findings do not definitely look like cancer but could be cancer. The radiologist will perform a biopsy. The findings in this category can have a wide range of suspicion levels. 
Category 5: Highly suggestive of malignancy -- Appropriate action should be taken 
The findings look like cancer and have a high chance (at least 95%) of being cancer. Biopsy is performed and surgery should be considered even if the biopsy result is non malignant.
Relevant Contraindications
Anticoagulation and biopsy 
Patients taking anti-coagulants will be booked for a biopsy when their INR is
Warfarin and Clopidogrel (Plavix) must be stopped for 48 - 72hrs prior to biopsy. A coagulation screen can be arranged by the clinic prior to biopsy if required
Breast MRI 
As for all MRI contraindications include
Implants contraindicated for MRI
Ferromagnetic aneurysm clip
Pacemaker
Other conditions may needs careful consideration
Pregnancy
Disability
Renal impairment as gadolinium contrast agent is utilized
Breast MR is performed at certain times of the menstrual cycle to maximize sensitivity and specificity in the hormonally responsive breast.  The Cork Private Breast Clinic will facilitate this process if required
Please contact our MR technicians with any concerns: Ph 021 494 1390 Fax: 021 494 1391
Post biopsy care
After biopsy a sterile temporary dressing is provided.  This does not routinely need redressing.  Patients are advised to utilize simple analgesics such as paracetamol rather than non-steroidal agents to minimize any bruising and bleeding.
A bruise is expected after breast biopsy due to the nature of the breast itself.  Bleeding and infection are rare complications.  Some patients may benefit from the use of an icepack after biopsy to aid in pain relief.  Similarly a well fitting bra is advised.  

Process of Referral

Rapid access triple assessment and diagnostic services are available.

Our Breast Care Coordinator, Mrs Sheila Creedon streamlines care throughout the process.

Online referral forms are available here

  • Clinical assessment (including diagnostic imaging)
    • Radiology and pathology reports will still be supplied to the referring GP 
  • Breast imaging only assessment

To book a routine appointment (to be arranged at the patients convenience, within one week)

Fax: (021) 4941369

 

To book an urgent appointment please contact: 

Mobile: Breast Care Coordinator: 086 877 6825

 

Process of Assessment

After meeting with Mrs Sheila Creedon, our Breast Care Coordinator the patient is referred to the Breast Imaging Unit.  If a clinical examination is required, this will be facilitated. 

Typically imaging will entail:

  • Mammogram and/or
  • Ultrasound

Whilst not all patients require multimodality assessment more complex cases not uncommonly require several tests to reach complete and accurate diagnosis.

A standard mammogram and ultrasound often lead to may lead to further investigations such as:

  • Further mammographic views to characterize masses, architectural distortions and calcifications including:
    • Spot Compression Views
    • Magnification Views
  • Biopsy which includes:
    • Ultrasound Guided Biopsy
    • Stereotactic Guided Biopsy
    • Fine needle aspiration and cytology
  • Magnetic Resonance Imaging (MRI)

If a biopsy or fine needle aspiration is required this will be performed on the same day.

After imaging assessment patients will meet with Breast Surgeons to discuss their results and any ongoing management.  

Results

Radiology reports and surgical assessments will be available (faxed) in 48 hours to the referring clinician.

Biopsy results have a 7-day turnaround.  This is ensure a multidisciplinary assessment and discussion to ensure concordance.

Please contact us for urgent reports or queries.

 

Breast Imaging Reports 

The system used in the conclusion of all imaging reports is the R score. A similar score is also used for the clinical assessment (S score) and pathological biopsy review (B score), cytology results (C score).  The combination of scores is discussed in a multidisciplinary to ensure concordance.  Discordance leads to further investigation.

Category 1: Negative 

In this case, there is no significant abnormality to report. The breasts look the same (they are symmetrical) with no masses, distorted structures, or suspicious calcifications. 

Category 2: Benign (non-cancerous) finding 

This is also a negative mammogram result, but the reporting doctor chooses to describe a finding known to be benign, such as benign calcifications, intra-mammary lymph nodes, or calcified fibroadenomas. This ensures that others who look at the mammogram will not misinterpret this benign finding as suspicious. 

Category 3: Probably benign finding 

The findings in this category have a very good chance (greater than 98%) of being benign.  The findings are not expected to change over time. Often these lesions are biopsied to prove they are benign, particularly if there is a new symptom and/or no previous mammogram.

Category 4: Suspicious abnormality - Biopsy should be considered 

Findings do not definitely look like cancer but could be cancer. The radiologist will perform a biopsy. The findings in this category can have a wide range of suspicion levels. 

Category 5: Highly suggestive of malignancy - Appropriate action should be taken 

The findings look like cancer and have a high chance (at least 95%) of being cancer. Biopsy is performed and surgery should be considered even if the biopsy result is initially non-malignant.

Relevant Contraindications

Anticoagulation and Biopsy 

Patients taking anti-coagulants such as Warfarin or Clopidogrel will often be booked after medication is withheld.  Obviously this will depend upon the clinical setting, indication for anticoagulation and urgency of the diagnosis.  The withholding of medication will only be requested after discussion with the referring clinician.

Breast MRI 

As for all MRI contraindications include:

  • Implants contraindicated for MRI
    • Ferromagnetic aneurysm clips
    • Pacemaker
    • Recent coronary stents
  • Other conditions need careful consideration
    • Pregnancy
    • Disability
    • Renal impairment as gadolinium contrast agent is utilized

Breast MR is performed at certain times of the menstrual cycle to maximize sensitivity and specificity in the hormonally responsive breast.  The Cork Private Breast Clinic will facilitate this process when required.

Please contact our Breast Care Coordinator with queries.

Post Biopsy Care

After biopsy a sterile temporary dressing is provided.  This does not routinely need redressing.  Patients are advised to utilize simple analgesics such as paracetamol rather than non-steroidal agents to minimize bruising and bleeding.

A bruise is expected after breast biopsy. Bleeding and infection are rare complications.  Some patients may benefit from the use of an icepack after biopsy to aid in pain relief and reduce swelling.  Similarly a well fitting bra is advised.  Patients are advised to keep the area clean and dry for 24 hours.  Patients will be supplied with verbal and written information after the biopsy as well as a phone number to contact with any concerns.