Resource-Stratified Matrix Guidelines

Diagnosis and Pathology

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Level of resources
Clinical
Pathology
Imaging and lab tests
Basic

History

Physical examination

Clinical breast examination

Surgical biopsy

Fine-needle aspiration biopsy

Interpretation of biopsies

Cytology and/or pathology report describing tumor size, lymph node status, histologic type, tumor grade

 
Limited

Core needle biopsy

Image guided sampling (ultrasounographic +/- mammographic)

Determination and reporting of ER and PR status

Determination and reporting of margin status

Diagnostic breast ultrasound +/- diagnostic mammography

Plain chest radiography

Liver ultrasound

Blood chemistry profile / complete blood count (CBC)

Enhanced

Preoperative needle localization under mammographic or ultrasound guidance

On-site cytopathologist

Diagnostic mammography

Bone scan

Maximal

Stereotactic biopsy

Sentinel node biopsy

HER-2/neu status

IHC staining of sentinel nodes for cytokeratin to detect micrometastases

CT scanning, PET scan, MIBI scan, breast MRI

ABBREVIATIONS: ER, estrogen receptors; PR, progesterone receptors; CBC, complete blood count; IHC, immunohistochemistry


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