Impact of a Structured Multidisciplinary Tumour Board on Staging, Treatment Planning and Breast Conservation in Newly Diagnosed Breast Cancer: Interim Analysis from a Tertiary Centre in Bangladesh
Authors: Md. Arifur Rahman1*, Ayesha Siddika2, Mesbah Hasin3, Ferdous Ara Begum4, Mashud Parvez5, Sharmin Akter Rupa6, Salma Sultana7, Qamruzzaman Chowdhury1
Institution: Bangladesh Specialized Hospital PLC
Introduction
Multidisciplinary tumour boards (MDTs) are recommended standard of care for breast cancer, but evidence of their impact on management in South Asian, resource-constrained settings is limited. We evaluated how a structured breast MDT influenced staging, treatment intent, surgical planning and neoadjuvant pathways in newly diagnosed breast cancer at a tertiary centre in Bangladesh.
Methods
This retrospective analysis of a prospectively maintained institutional registry included consecutive patients with newly diagnosed, biopsy-proven breast cancer discussed at the Bangladesh Specialized Hospital breast MDT between November 2022 and September 2025. The board comprised a breast surgeon, radiologist, pathologist, medical oncologist, radiation oncologist and clinical oncologist, with cardiology, diabetology and anaesthesia input when needed. Standard work-up included bilateral ultrasound, mammography, core biopsy of all suspicious breast and axillary lesions, and ER/PR/HER2/Ki-67 immunohistochemistry; the MDT advised breast MRI, PET-CT, bone scan, genetic testing or pathology review when needed. Endpoints were the recommendation of additional investigation, stage migration, newly detected bilateral or metastatic disease, the category of MDT decision, surgical-plan modification, conversion to breast-conserving surgery (BCS), adherence and pathological complete response (pCR; ypT0/is ypN0) after neoadjuvant chemotherapy (NACT). Proportions were calculated using patients with each variable recorded as the denominator. Data entry is ongoing; this is an interim analysis.
Results
Of 263 patients (median age 52 years, range 25–82; 32.3% premenopausal), 63.6% presented with stage II disease, 10.7% with stage III and 12.4% with stage IV. The molecular subtypes were luminal B HER2-negative (28.0%), triple-negative (26.3%), luminal A (22.8%), luminal B HER2-positive (15.9%) and HER2-enriched (6.9%). A median of six specialties attended each discussion, and the full core quorum was present in 67.9%. The MDT recommended additional investigation in 204 of 262 patients (77.9%), most often multimodality imaging. Among 135 patients with complete MDT-impact documentation, 15 of 131 assessable cases (11.5%) had stage migration (9 upstaged, 6 downstaged), and distant metastasis was newly detected in 14 of 129 (10.9%). Suspicious bilateral disease was identified in 15 of 131 (11.5%). The MDT's decisions fell into these categories: curative-intent multimodality treatment (63.7%), further work-up before treatment (14.8%), palliative intent (11.9%), surgery brought forward (5.9%) and escalation of systemic therapy (2.2%). The surgical plan was modified in 119 of 134 patients (88.8%), and 70 of 119 eligible patients (58.8%) were directed to a breast-conservation pathway. Of 115 patients whose adherence could be assessed, 106 (92.2%) were treated as recommended. The median interval from MDT to first treatment was 9 days (IQR 4–17). Sixty patients received NACT, with hydrogel marker placement in 67.3%. pCR was achieved in 19 of 48 evaluable patients (39.6%): 56.3% in triple-negative disease and 53.3% in HER2-positive disease. Of 128 operated patients, 86 (67.2%) underwent BCS, including 35 of 53 (66.0%) after NACT.
Conclusion
In this interim analysis, structured MDT review frequently prompted additional investigation, refined staging in about one in nine patients and identified previously unrecognised metastatic disease in about one in ten. It also shaped surgical strategy, achieving a breast-conservation rate approaching two-thirds, including after NACT. Adherence to MDT recommendations was high, and the time from board to treatment was short. These findings support routine multidisciplinary review for every newly diagnosed breast cancer in Bangladesh. Completion of the full 2019–2026 cohort will allow assessment of locoregional control, cosmesis and survival outcomes.