Preoperative Needle Biopsy as a Potential Quality Measure in Breast Cancer Surgery
Preoperative needle diagnosis (PND) is being considered as a quality measure in breast cancer surgery. This criterion has not been thoroughly evaluated in the literature. The purpose of this study is to assess ease of access to these data and rate of compliance in a tertiary care center. We retrospectively reviewed all our breast cancer cases between July 2006 and July 2007. The data were queried for preoperative needle diagnosis. Charts of patients who did not meet this criterion were reviewed to determine the cause for noncompliance. In the year 2006–2007, 396 breast cancer operations were performed (age range 19–96 years). Of 396 cases, 43 (11%) underwent a surgical procedure without diagnosis of cancer. In 19/396 (5%) cases PND was not feasible due to technical reasons. In 22/396 (5.5%) cases, preoperative needle biopsy did not render a malignant diagnosis: the pathology report was discordant with the radiological or clinical findings, or the needle biopsy result necessitated surgical resection. In only 2 of 396 cases (0.5%) was PND not attempted: an 80-year-old woman with a radiologically and clinically malignant mass, and a 43-year-old woman with a clinical and ultrasonographic suggestion of fibroadenoma. We conclude that data for preoperative needle diagnosis were easily accessible in our center. If this criterion is used as a quality measure in breast cancer surgery, 100% compliance may not be an achievable goal.
- 6.Julian TB, et al. Decrease false-negative rate with SLNBx. NSABP-B32. San Antonio 2007, Abstract #51.Google Scholar
- 7.Anonymous (November 2006) The National quality Forum, “National Voluntary Consensus Standards for Diagnosis and Treatment of Breast and Colon Cancer”. http://www.qualityforum.org/pdf/cancer/txbreast-colonALLwebposting.pdf. Accessed 14 Jul 2008.
- 8.US Food and Drug Administration. Department of Health and Human Services. Center for Devices and Radiological Health. Mammography Information for mammography facility personnel, inspectors, and consumers about the implementation of the Mammography Quality Standards Act of 1992 (MQSA). Available: http://www.fda.gov/CDRH/MAMMOGRAPHY. Accessed 14 Jul 2008.
- 11.Fajardo LL, DeAngelis GA. The role of stereotactic biopsy in abnormal mammograms. Surg Oncol Clin North Am. 1997;6:285–9.Google Scholar
- 16.Brem RF, Behrndt VS, Sanow L, et al. Atypical ductal hyperplasia: histologic underestimation of carcinoma in tissue harvested from impalpable breast lesions using 11-guage stereotactically guided directional vacuum-assisted biopsy. Am J Roentgenol. 1999;172:1405–7.Google Scholar