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Canisius Wilhelmina Ziekenhuis
Nijmegen, Netherlands
Social Workers
Nutritional Counselling
Survivorship Groups
Sexual Health Counselling
Supportive and Palliative Care
Integrative Medicine
Radiology![](/images/01/common/tab/arrowright.gif)
Dedicated Radiologists4
Mammograms per year8500
Breast radiographers
Screening program
Verification for non-palpable breast lesions on specimen
Axillary US/US-guided FNAB
Clinical Research
Available imaging equipment
Mammography
Ultrasound
Magnetic Resonance Imaging (MRI)
digital tomomammography
Available work-up imaging equipment
Computer Tomography
Ultrasound
Magnetic Resonance Imaging (MRI)
PET/CT scan
Primary technique for localizing non-palpable lesions
Hook-wire (or needle localization)
Charcoal marking/tattooing
ROLL: radio-guided occult lesion localization
Available breast tissue sampling equipment
Stereotactic Biopsy (Mammography guided)
Core Biopsy (Tru-cut)
Vacuum assisted biopsy
Ultrasound-guided biopsy
Fine-needle aspiration biopsy (FNAB, cytology)
Core Biopsy
Vacuum assisted biopsy
MRI-guided biopsy
Core Biopsy
Vacuum assisted biopsy
Breast Surgery![](/images/01/common/tab/arrowright.gif)
New operated cases per year (benign and malignant)
367
Dedicated Breast Surgeons
4
Surgeons with more than 50 surgeries per year
3
Breast Surgery beds
7
Breast Nurse specialists
4
Outpatient surgery
Intra-operative evaluation of sentinel node
Reconstruction performed by Breast Surgeons
Clinical Research
Primary technique for staging the axilla
Axillary lymph node dissection
Sentinel lymph node biopsy:
Blue dye technique
Radio-tracer technique
Blue dye + Radio-tracer
Axillary sampling
Reconstructive/Plastic Surgery![](/images/01/common/tab/arrowright.gif)
Reconstructive/Plastic surgeons
3
Immediate Reconstruction available
Type of breast reconstructive surgery available
Remodelling after breast-conserving surgery
Reconstruction after mastectomy:
Two-stage reconstruction (tissue expander followed by implant)
One-stage reconstruction
Autogenous tissue flap
Latissimus dorsi flap
Transverse rectus abdominis (TRAM)
Free-flaps (free TRAM, DIEP, SIEA, gluteal, etc.)
Surgery on the contralateral breast for symmetry
lipofilling
Pathology![](/images/01/common/tab/arrowright.gif)
Dedicated Breast Pathologists
3
Available studies
Cytology
Haematoxylin & eosin section (H&E)
Surgical specimen
Sentinel node
Core biopsy
Frozen section (FS)
Surgical specimen
Sentinel node
Immunohistochemistry stain (IHC)
Estrogen receptors
Progesterone receptors
HER-2
Ki-67
Other special studies available
Fluorescence in-situ Hybridization for HER-2 gene (FISH)
Oncotype Dx (21-gene assay)
MammaPrint (70-gene microarray)
Prediction Analysis of Microarray 50-gene set (PAM 50)
Parameters included in the final pathology report
Pathology stage (pT and pN)
Tumour size (invasive component in mm)
Histologic type
Tumor grade
ER/PR receptor status
HER-2/neu receptor status
Peritumoural/Lymphovascular invasion
Margin status
DCIS
Medical Oncology![](/images/01/common/tab/arrowright.gif)
Dedicated Breast Medical Oncologists
3
Outpatient systemic therapy
Clinical Research
Radiotherapy![](/images/01/common/tab/arrowright.gif)
Dedicated Radiation Oncologists
Clinical Research
Available techniques after breast-conserving surgery (including experimental)
Whole-Breast RT (WBRT)
Partial breast irradiation (PBI):
External beam PBI
Interstitial brachytherapy
Targeted brachytherapy (MammoSite, SAVI applicator, other devices)
Intra-operative RT (IORT)
axillary RT as alternative to ALND, hyperthermia
Multidisciplinary Meeting (MDM) / Tumour Board (TB)
Regular MDM/TB for case management discussion
Twice a week
Weekly
Every two weeks
Other Schedule
Cases discussed at MDM/TB
Preoperative cases
Postoperative cases
Specialties/services participating in MDM/TB
Radiology
Breast Surgery
Reconstructive/Plastic Surgery
Pathology
Medical Oncology
Radiotherapy
Genetic Counselling
Breast Nurse Service
Psycho-oncology
nuclear medecine
Further Services and Facilities
Nuclear Medicine
Lymphoscintigraphy
Bone scan
Positron Emission Tomography (PET)
PET/CT scan
Rehabilitation
Prosthesis service
Physiotherapy
Lymph-oedema treatment
integral exercise & reintegration program
Genetic Counselling
Specialist Providing Genetic Counselling/Risk assessment service:
Dedicated Clinical Geneticist
Medical Oncologist
Breast Surgeon
General Surgeon
Gynaecologist
Genetic Testing available
Surveillance program for high-risk women
Data Management
Database used for clinical information
Data manager available
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