Metric 07

Metric Category: Appropriateness

Re-excision After Initial Breast Conserving Surgery

About the Metric

Definition

The percentage of patients who underwent a re-excision within 3 months after the initial breast-conserving therapy (i.e. partial mastectomy or “lumpectomy”).

Background

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.

Cornerstone (index) event of the measure

Initial BCT operation

Metric Ratings

Evidence
4/5
Expert Consensus
5/5
Clinician Buy-in
3.5/5
Economic Impact
4/5
Reduction in Avoidable Harm
4/5
Applicability to Medicare Data
4.5/5
Applicability to Medicaid
5/5

Applicable to EHR Data?

Requires Pharmacy Data?

How It Works

Numerator

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. 

Denominator

The number of patients who underwent an initial breast-conserving therapy (BCT) (CPT codes: 19120, 19125, 19126, 19301, 19302) performed by a given physician. 

Inclusion Criteria

  1. Patients 18 years of age or older
  2. A diagnosis of breast cancer (ICD-10-CM codes: C50.011 – C50.929, D05.00-D05.92) anytime within 3 months before or after their initial breast conserving therapy (BCT)
  3. Three months of continuous data before the index BCT and 3 months of continuous data after BCT

Exclusion Criteria

  1. Patients with any history of prior modified radical or radical mastectomy (CPT codes:, 19303, 19305, 19306, 19307) before the day of the patient’s initial breast conserving therapy (BCT) (CPT codes: 19120, 19125, 19126, 19301, 19302)
  2. Patients whose initial breast conserving therapy (CPT codes: 19120, 19125, 19126, 19301, 19302) was performed by multiple surgeons

  3. Patients who received a re-excision procedure by a surgeon different from the one who performed the initial breast conserving therapy (BCT)
  4. Patients with less than 3 months’ medical history available prior to their initial breast conserving therapy (BCT)

  5. Patients of male sex

GAM Thresholds™

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.

  • Sample Size: 10+

    This threshold applies to a clinician with a minimum of 10 cases.

  • Pattern of Concern: 25-30%

    This constitutes the clinical threshold for a "pattern of concern".

  • Outlier: >30%

    This constitutes the clinical threshold for an "outlier".

Cases Pattern of Concern Outlier
10+
25-30%
>30%