Metric 08

Use of Needle Biopsy Before Breast Surgery

Metric Category: Appropriateness

About the Metric

Definition

The percentage of patients who underwent breast core needle biopsy within 3 months prior to their initial breast surgery to remove a mass or lesion. 

Background

The American Society of Breast Surgery has endorsed 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 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 biopsy 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. 

Metric Ratings

Evidence
5/5
Expert Consensus
5/5
Clinician Buy-in
5/5
Economic Impact
3.5/5
Reduction in Avoidable Harm
4.5/5
Applicability to Medicare Data
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 breast core needle biopsy (CPT codes: 19081, 19082, 19083, 19084, 19085, 19086, 19100, 19101) within 3 months prior to their initial breast cancer surgery (CPT codes: 19120, 19125, 19126, 19301, 19302, 19303, 19304, 19305, 19306, 19307). 

Denominator

The number of patients who underwent an initial breast surgery (CPT codes: 19120, 19125, 19126, 19301, 19302, 19303, 19304, 19305, 19306, 19307) for breast cancer (ICD-10-CM codes: C50). 

Inclusion Criteria

All patients aged 18 years or older who underwent an initial breast cancer surgery during the study period. 

Exclusion Criteria

  1. Patients with any history of prior modified radical or radical mastectomy (CPT codes: 19125, 19126, 19301, 19302, 19120, 19303, 19304, 19305, 19306, 19307, 19100, 19101, 19102, 19103, 19081, 19082,19083, 19084,19085, 19086,19318, 19324, 19325, 19340, 19342, 19316) before the day of the patient’s initial breast conserving therapy (BCT) (CPT codes: 19120, 19125, 19126, 19301, 19302)
  2. Patients with less than 3 months of data available prior to their initial breast cancer surgery
  3. Any breast procedures performed for cosmetic purposes only (ICD: Z41.1)

Attribution

None.

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: 11+

    This threshold applies to a clinician with a minimum of 11 cases.

  • Pattern of Concern: 70-75%

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

  • Outlier: <70%

    This constitutes the clinical threshold for an "outlier".

Cases Pattern of Concern Outlier
11+
70-75%
<70%