Metric Category: Appropriateness
The percentage of patients who underwent a re-excision within 3 months after the initial breast-conserving therapy (i.e. partial mastectomy or “lumpectomy”).
The American Society of Breast Surgery has endorsed the use of a core needle biopsy prior to initial breast surgery as a quality metric in breast care. The National Comprehensive Cancer Network, and other international consensus groups have established a core needle biopsy as the preferred method for tissue sampling of breast pathology prior to initial breast cancer surgery. The National Accreditation Program for Breast Centers has published a standard that palpation-guided or image-guided needle biopsies should be the initial diagnostic approach rather than surgical excision. Variation in compliance with this guideline may represent a disparity in health care and a surrogate measure of unnecessary surgery.
Initial BCT operation
Applicable to EHR Data?
Requires Pharmacy Data?
The number of patients from the denominator who underwent a re-excision (CPT codes: 19120, 19125, 19126, 19301, 19302) performed by the same physician within 3 months after the initial breast-conserving therapy.
The number of patients who underwent an initial breast-conserving therapy (BCT) (CPT codes: 19120, 19125, 19126, 19301, 19302) performed by a given physician.
Patients whose initial breast conserving therapy (CPT codes: 19120, 19125, 19126, 19301, 19302) was performed by multiple surgeons
Patients with less than 3 months’ medical history available prior to their initial breast conserving therapy (BCT)
GAM establishes clinical thresholds using the input of key physician leaders within a specialty and the GAM clinical team. GAM utilizes an elaborate consensus building process with final adjudication by our leadership team.
|Cases||Pattern of Concern||Outlier|
1. Kaczmarski K, Wang P, Gilmore R, Overton HN, Euhus DM, Jacobs LK, Habibi M, Camp M, Weiss MJ, Makary MA. Surgeon Re-Excision Rates after Breast-Conserving Surgery: A Measure of Low-Value Care. J Am Coll Surg. 2019 Apr;228(4):504-512.e2.
2. Landercasper J, Bennie B, Ahmad HF, et al. Opportunities to reduce reoperations and to improve inter-facility profiling after initial breast-conserving surgery for cancer. A report from the NCDB. Eur J Surg Oncol 2019;45:2026-36. 10.1016/j.ejso.2019.07.002