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 6 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 6 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 breast operation (CPT codes: 19125, 19126, 19301, 19302, 19160, 19120, 19303, 19304, 19305, 19306, 19307, 19100, 19101, 19081, 19082,19083, 19084,19085, 19086,19318, 19324, 19325, 19340, 19342, 19316) before their initial breast cancer surgery (CPT codes: 19125, 19126, 19301, 19302, 19160, 19120, 19303, 19304, 19305, 19306, 19307)
  2. Patients with less than 6 months’ medical history available prior to their initial breast cancer surgery (CPT codes: 19125, 19126, 19301, 19302, 19160, 19120, 19303, 19304, 19305, 19306, 19307)
  3. Any breast procedures performed for purely cosmetic purposes (ICD: Z41.1)

Attribution

None.

GAM™ Thresholds

Minimal number of patients required in the denominator Clinical threshold of what constitutes a pattern of concern Clinical threshold of what constitutes an outlier
11 70-75% <70%

Related Publications

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. 

 

2. American Society of Breast Surgeons. Preoperative diagnosis of breast cancer quality measure.