Introduction & Objective: Revolutionary concept in the strategy of diagnosis and treatment of breast cancer in the last 30 years has significantly increased the accuracy of diagnosis and the quality of treatment while decreasing invasion to the patient.MULTIDISCIPLINARY TEAM WORK approach in the Specialized Breast Units is the key point in this new approach. Intimate collaboration of the breast surgeon with the interventional breast radiologist is the base of this MULTIDISCIPLINARY TEAM WORK. In this new approach the surgeon is in a real sense the one who treats the patient. The surgery is neither acceptable for diagnosis nor for staging purpose. Rather it is done only to treat the cancer mostly as a single stage and to remove symptomatic benign breast lesions. In this study MULTIDISCIPLINARY TEAM WORK based on this new concept and its role in increasing the accuracy of diagnosis and the quality of care while decreasing unnecessary surgery, is evaluated for the case of Iranian patients. Materials & Methods: Between March 2006 to Feb 2009, trucut biopsy was done for 505 patients with clinical suspicion and/or BIRADS III-V classification in imaging. If pathologic result and clinical suspicion were in concordance, surgery was replaced by short term follow up. Otherwise, and in the presence of moderate and severe hyperplasia, with or without atypia, lobular or papillary lesions guide wire open biopsy was done.Results: Cancer was found in 30% of the cases (24% in stereotactic and 46% in sono-guided biopsies). Moderate and severe hyperplasia with or without atypia, lobular or papillary lesions were found in 5%. There was 2% discordance between clinical/image suspicion and pathologic result.Conclusions: MULTIDISCIPLINARY TEAM WORK approach, especially by intimate collaboration between breast surgeon and interventional breast radiologist, can eliminate the need for surgery in 63% of the cases while increasing the accuracy of diagnosis. Pre-operative tissue diagnosis will decrease the expenses of diagnosis of breast disease and breast cancer significantly by omitting unnecessary surgeries, intra-operative pathologic evaluation by frozen section and one stage cancer treatment. This approach which is especially suitable for countries with limited health budget, improves the quality of diagnosis and treatment for breast disease and especially breast cancer.

Purpose: The prostate cancer (PCa) treatment is multimodal. Thus MULTIDISCIPLINARY TEAM management (MDTM) decision-making process appears as a tool to answer all aspects of PCa treatment. Our aim was to evaluate the reproducibility of therapeutic decisions made at MDTM. Materials and Methods: We compared therapeutic decisions of PCa by presenting the same file of patient under a fake identity after 6 to 12 months from the first presentation. Forty-nine files of radical prostatectomy (RP) (28 pT2, 21 pT3) performed for clinical localized PCa were represented at MDTM which included urologist, oncologist, pathologist and radiologist. Analysis of therapeutic decisions comprised criteria such as: TNM stage, Gleason score, margin status and comorbidities. The reproducibility was assessed statistically by Kappa coefficient. Results: Study subjects included 49 patients who underwent radical prostatectomy (RP). The mean age was similar in pT2 and pT3 groups (P =. 09). The mean serum PSA value was 8. 32 ng/mL (range, 3. 56-19. 5) in pT2 group and 9. 4 ng/mL (range, 3. 8-22) in pT3 group. The margin status in pT2 and pT3 groups was positive in 25. 0% and 47. 6%, respectively. The decisions made at first and second MDTM for pT2 group were the same in 100% of cases with a perfect kappa coefficient (k = 1). In the group of pT3 (n = 21), the decisions were different in 33% at the second MDTM in comparison to the first MDTM. Especially for pT3b only 29% were reproducible decision with a slight agreement (k = 0. 1). Concerning pT3a, 86% of the decisions were reproducible with a substantial agreement (k = 0. 74). Conclusion: We showed a reliability and reproducibility of decision made at MDTM when guidelines are well defined. The therapeutic attitudes were less reproducible in locally advanced PCa but decision concerning those cases should be made in the setting of guidelines.

Background: Post-mastectomy radiation therapy (PMRT) is a key component in managing breast cancer with increased potential for locoregional recurrence. Breast reconstruction has evolved to include various techniques that can be categorized according to the type of reconstruction (implant-based versus autologous reconstruction), and the timing of reconstruction (one versus two-step techniques). Methods/Results: This review article aims to provide a digestible summary of PMRT in the context of breast reconstruction by summarizing salient existing literature with a focus on considerations of the plastic surgeon. The main findings summarized in this review include the technique and timing of breast reconstruction, how breast reconstruction can affect radiation delivery, and the type of reconstruction. Within implant-based reconstruction, existing data on the location of the implant in the context of PMRT and PMRT delivery to the tissue expander versus permanent implant are reviewed. Each consideration may alter the probability of successful reconstruction and patient satisfaction. Conclusion: It is essential for the MULTIDISCIPLINARY breast cancer TEAM to have knowledge of the various reconstructive options, and to understand the safety and comparative effectiveness of staged reconstruction in the setting of PMRT. Additionally, one must consider that reconstructive procedures may have implications on the timely administration of PMRT. This review serves as a reference for members of the oncologic care TEAM when discussing reconstructive options with patients who will receive PMRT as part of their treatment plan.