⚠ DIAGNOSTIC PHASE — TREATMENT PLAN NOT YET APPLICABLEDIAGNOSTIC PHASE — TREATMENT PLAN NOT YET APPLICABLE. Histology required before any therapy discussion (CHARTER §15.2 C7).
Patient
PZ-DIAG-BREAST-001 · suspicion lineage: breast_carcinoma
Tissues: breast, axillary_lymph_nodes · Hypotheses: DIS-BREAST
52F with self-detected palpable_breast_mass in left upper-outer quadrant x 6 weeks. Diagnostic mammography shows birads_4_or_5 spiculated 2.4 cm mass with associated mammographic_abnormality (pleomorphic microcalcifications). Targeted breast US confirms hypoechoic irregular lesion with posterior shadowing. Mild ipsilateral axillary_lymphadenopathy (one 1.3 cm node, lost fatty hilum). No nipple_discharge, no skin_retraction, no peau_d_orange. No prior breast imaging.
Matched workup: WORKUP-SUSPECTED-BREAST · Очікуваний термін: ~ дnoв
Workup steps (5)
- 1imaging Diagnostic mammography (bilateral) ± tomosynthesis
First-line breast imaging for any palpable mass, focal pain, nipple discharge, or screening abnormality in women ≥30. Tomosynthesis improves cancer detection and reduces recall in dense breasts.
- 2imaging Bilateral breast and axillary ultrasound
Adjunct to mammography for characterizing palpable mass, evaluating dense breast tissue, guiding core-needle biopsy, and screening axillary nodes for clinical staging.
- 3lab Complete Blood Count with Differential
Baseline cytopenia assessment and ongoing monitoring of myelosuppression.
- 4lab Comprehensive Metabolic Panel
Електроліти (Na, K, Cl, HCO3), креатиnoн + BUN (renal function), глюкоза, кальцій, альбумін, total protein. Базова метаболічна оцінка перед будь-якою терапією + основа TLS risk + dosing adjustments.
- 5lab Liver Function Tests
Assess hepatic function — baseline + during BR cycles + DAA therapy + HBV reactivation monitoring.
MDT brief
MDT talk tree (3 steps)
| # | Owner | Topic | Action |
|---|
| 1 | pathologist | Specialist review | Any suspicion requires biopsy — pathologist plans site selection, IHC panel, ancillary tests. |
| 2 | radiologist | Specialist review | Stage / restaging imaging + biopsy guidance — radiologist. |
| 3 | surgical_oncologist | Specialist review | Suspected solid tumor — resectability assessment, biopsy approach. |
Skills (required) — mandatory virtual specialists (2)
- Pathologist (general) required
Any suspicion requires biopsy — pathologist plans site selection, IHC panel, ancillary tests.
- Radiologist required
Stage / restaging imaging + biopsy guidance — radiologist.
Skills (recommended) — for consideration (1)
Technical MDT skill metadata (3/16 activated in this plan)
All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).
| Specialist | skill_id | Version | Last reviewed | Sign-offs | Domain |
|---|
| Cellular therapy specialist (CAR-T) | cellular_therapy_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
| Clinical pharmacist | clinical_pharmacist | v0.1.0 | 2026-04-25 | 0 | clinical_pharmacy |
| Hematologist / oncohematologist | hematologist | v0.1.0 | 2026-04-25 | 0 | hematology_oncology |
| Hematopathologist (lymphoma / leukemia / myeloma) | hematopathologist | v0.1.0 | 2026-04-25 | 0 | hematopathology |
| Infectious disease / hepatology | infectious_disease_hepatology | v0.1.0 | 2026-04-25 | 0 | infectious_diseases |
| Medical oncologist (solid-tumor chemotherapist) | medical_oncologist | v0.1.0 | 2026-04-25 | 0 | solid_oncology |
| Molecular geneticist / molecular oncologist | molecular_geneticist | v0.1.0 | 2026-04-25 | 0 | molecular_oncology |
| Palliative care | palliative_care | v0.1.0 | 2026-04-25 | 0 | palliative_care |
| Pathologist (general) | pathologist | v0.1.0 | 2026-04-25 | 0 | pathology |
| Primary care / family physician | primary_care | v0.1.0 | 2026-04-25 | 0 | primary_care |
| Psycho-oncologist | psychologist | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Radiation oncologist | radiation_oncologist | v0.1.0 | 2026-04-25 | 0 | radiation_oncology |
| Radiologist | radiologist | v0.1.0 | 2026-04-25 | 0 | diagnostic_imaging |
| Social worker / case manager | social_worker_case_manager | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Surgical oncologist | surgical_oncologist | v0.1.0 | 2026-04-25 | 0 | surgical_oncology |
| Transplant specialist (BMT) | transplant_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |