The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on interstitial laser therapy for fibroademomas of the breast.
As part of the NICE's work programme, the current guidance was considered for review in June 2009 but did not meet the review criteria as set out in the IP process guide. The guidance below therefore remains current.
A fibroadenoma is a benign (non-cancerous) solid lump of tissue, which is thought to result from increased sensitivity to the hormone oestrogen. It normally has a rubbery texture, is smooth to the touch and moves easily under the skin. Fibroadenomas are very common and it is not unusual to have more than one. They are mostly found in young women but can occur in women of any age.
Laser therapy aims to destroy the tissue that has formed the fibroadenoma by the use of high-energy light. In this technique laser light is delivered to the lesion(s) via fibres positioned through needles inserted percutaneously into the breast under local anaesthetic, and guided to the fibroadenoma by imaging equipment, usually ultrasound. The presterilised bare fibre is passed a short distance beyond the tip of the needle, and laser energy is delivered through this fibre. The energy is delivered in continuous wave mode for a few minutes. For larger lesions multiple needles are inserted 1 cm apart, with a laser fibre through each.
The potential benefits of interstitial laser therapy are possibly lower rates of infection than open surgery, and a more acceptable aesthetic result.
B40.1 Interstitial laser destruction of lesion of breast
Note: The OPCS-4.5 code Y53.2 Approach to organ under ultrasonic control can be assigned in addition if ultrasonic guidance is utilised.
In addition the ICD-10 code D24.X Benign neoplasm of breast would be recorded.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.