American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Standard 2.9: Needle Biopsy

Palpation-guided or image-guided needle biopsy is the initial diagnostic approach rather than open biopsy.

Definition and Requirements

Either fine-needle aspiration for cytologic evaluation or core needle biopsy constitutes the initial diagnostic approach for palpable or occult lesions. Open surgical biopsy as an initial approach should be avoided, as it does not allow for treatment planning and is associated with a high reexcision rate. In those instances when open surgical biopsy is used, the reason for its use is documented in the medical record.

Performance Measure

The NAPBC requires the Breast Program Leadership Committee (BPLC) to review the quality of patient care using the NAPBC-identified performance measures appropriate to the patients who are treated by the center each year.

Performance Measure

Needle/core biopsy is performed prior to surgical treatment of breast cancer.

Process Requirements

Accession List and Data Review Requirements for the Site Visit

The center is required to provide a de-identified accession (case) list of breast cancer cases diagnosed and/or treated at the center (class of case 10–22) prior to the site visit date. Class of case is defined in the Facility Oncology Registry Data Standards (FORDS) manual.

The BPLC evaluates the overall needle biopsy rate annually for cancer patients. When open surgical biopsy is used, the reason for its use is documented in the medical record.

Compliance is reviewed annually by the BPLC.

Documentation

Complete all required standard fields in the Survey Application Record (SAR).

Calculate and record the overall needle biopsy rate annually for cancer patients (overall needle biopsy rate is calculated by the number of needle biopsies performed/total number of biopsies of breast cancer patients).

Document the annual audit by the BPLC in the meeting minutes.

Evaluation

The surveyor will review patient medical records during the medical records review portion of the site visit to evaluate the utilization of palpation-guided or image-guided needle biopsy and open surgical biopsy.

Rating Compliance

Compliance

  1. Palpation-guided or image-guided needle biopsy is the initial diagnostic approach rather than open biopsy.
  2. When open surgical biopsy is used, the reason for its use is documented in the medical record.
  3. Compliance is reviewed annually by the BPLC and documented in the meeting minutes.

Noncompliance

The center does not fulfill one or more of the compliance criteria.