Examination

1
TRIPLE ASSESSMENT OUTLINE
OUTPUT/ OUTCOMES
INPUT
TRIPLE ASSESSMENT
Discharge
GPs
Further Investigation
GP
Examination Radiology Pathology
Discuss MDM
Diagnosis Thx Planning Results
Other
Surgery
Genetic/Risk Assessment
Routine Follow up
2
Symptom Pathways (Breast Lump)
Treat
Aspirate to Histopathology
Review for Diagnosis Book date Inform GP
Pus
Discharge Inform GP
Disappears, aspirate Blood stained, particulate
Examination Radiology Pathology Outcome
Aspirate
Disappears, clear fluid
Cystic
Agelt 35
Clinical Examination
Yes
Ultrasound
Residual lump remaining
Histopathology FNA/ Core Biopsy
Solid
No (No other Symptoms/ Family history)
Patient referred with breast lump
Reassure Discharge/ Inform GP
Solid
High index suspicion anxious patient
Low index Suspicion/ Benign
Clinical Examination
Mammography /- Ultrasound
Yes
Agegt35
Review for Diagnosis/ Staging/ Therapy
planning (book appointment)
Cystic
Offer Patient Surgical removal
Residual lump remaining
Disappears Blood stained/ particulate
Aspirate to Histopathology
Aspirate
Yes
Disappears Clear fluid
No
Pus
Review for Diagnosis Book date Inform GP
Book date For surgery pr e assessment
Recall for Follow up Book date
Discharge GP to monitor
Discharge GP letter
Treat
3
Nipple Discharge Pathway
Mammography/ USS
Patient referred with Nipple discharge
Not breast feeding
History Medication
Erythema inflamation
Breast feeding
Lump
Clinical examination
No lump
Manage as lump
Advise/ treat
Single duct
Multiple ducts/ bilateral
Nipple eczema
Large volume, Blood stained or persistant
Blood stained
Manage As Nipple eczema
Non blood Stained/ Clear
Large volume persistant
Mammography gt35 USS lt 35
Radiological abnormality
Small volume
Lactating pregnant
Endocrine abnormality
No
Arrange Radiological Guided biopsy
No other signs
No abnormality
yes
Reassure/ observe
Investigate/ Treat/ Refer
Arrange needle Localised Excision biopsy Book
theatre, x-ray ? Pre assessment
Total duct Excision (multiple duct)
Microdochectomy (single duct)
? Duct endoscopy
4
Breast Pain Pathway
Allotted sign pathway
Patient referred with Breast Pain
Breast Lump pathway
Other signs
Assymetrical Nodularity pathway
Full history
Breast Lump
Arrange admission For needle localised Excision
biopsy
Clinical examination
Assymetrical nodularity
Arrange Radiological Guided biopsy
Cyclical
Non Cyclical
Mild/ Moderate
Mild/ Moderate

severe
Severe
Radiological abnormality
Reassure/ Simple measures
Reassure/ Simple measures
Diffuse
Localised
persistant
Persistant
Refer Mastalgia clinic
Radiology
No abnormality