Designed for surgeons, radiologists and pathologists who deal with the clinical diagnosis and treatment of breast disease, this book will also serve as a good review for residents preparing for the Royal College examinations.
The book begins by outlining the principles of a multidisciplinary approach to the diagnosis and treatment of breast disease. The exercise of these principles is then illustrated with 50 interesting cases. The protocols that are followed were developed in Nottingham, UK, and they emphasize the teamwork required among surgeon, radiologist and pathologist. The first section, which would be extremely useful to clinic planners and managers, is a detailed description of a complex network of clinics and their workings. This is followed by a series of classification schemes that are used to generate elaborate algorithms for the clinical management of the various diseases that are encountered in clinical practice.
The book is extremely well written, with a British style and, as promised in the title, the cases clearly illustrate the basic principles set out in the first part of the text. There is a European flavour to the terminology and some of the procedures; “double-node biopsy” is one example. Many potential clinical pitfalls are highlighted effectively. There is an abundance of illustrations with superb images of mammograms, and histologic and ultrasonographic findings. The organization and the presentation are exceptional.
On the downside, although the opening chapters emphasize the importance of teamwork, there is no mention of involvement of the oncologist or the radiotherapist. In our clinic, these specialists play an integral role. The captions accompanying the illustrations are all repeated in the text, which makes for inefficient reading. I was left wondering about the approaches to some of the cases. For example, in some cases both fine-needle aspiration and core biopsies were done (case 2). The index was not extensive, and after some time casting about the introductory section I was unable to find an explanation of an “H-score.” In some cases the clinical decisions are well referenced with evidence being given for the decisions made (case 8). But many other cases are not referenced, and occasionally dogmatic decisions are made (case 9). It was unclear as to why ultrasonography was used as a guide for palpable lesions (cases 9 and 10). The reason why a core biopsy needed to be obtained on an exophytic lesion was not obvious, since biopsy with a scalpel would have sufficed (case 19). I do not advocate ultrasonography with simple palpable cysts as the authors do in case 20. Also, it was not clear why preoperative mammography was omitted in case 27. There were other cases in which ultrasonography was used when it would not change the management, and as a general principle we do not use it in all cases.
In spite of these differences of opinion, I consider this beautifully illustrated book to be a very useful review of a broad variety of clinical cases of breast disease. The organization of the book makes it particularly easy to read because it can be picked up and put down as often as necessary without the reader losing the train of thought.