Metric Category: Appropriateness
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.
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.
Applicable to EHR Data?
Requires Pharmacy Data?
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).
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).
All patients aged 18 years or older who underwent an initial breast cancer surgery during the study period.
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.
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1. Gilmore RC, Wang P, Kaczmarski K, Hutfless S, Euhus DM, Jacobs LK, Habibi M, Lange J, Camp M, Makary MA. Under-utilization of Needle Biopsy Before Breast Surgery: A Measure of Low-Value Care. Annals of Surgical Oncology. 2021.