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Complete Summary


TITLE

Pathology: percentage of breast cancer resection pathology reports that include the pT category (primary tumor), the pN category (regional lymph nodes) and the histologic grade.

SOURCE(S)

  • College of American Pathologists (CAP), Physician Consortium for Performance Improvement®. Pathology physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2007 May. 12 p. [4 references]

Measure Domain

PRIMARY MEASURE DOMAIN

SECONDARY MEASURE DOMAIN

Does not apply to this measure

Brief Abstract

DESCRIPTION

This measure is used to assess the percentage of breast cancer resection pathology reports that include the pT category (primary tumor), the pN category (regional lymph nodes) and the histologic grade.

RATIONALE

Therapeutic decisions for breast cancer management are stage driven and cannot be made without a complete set of pathology descriptors. Incomplete cancer resection pathology reports may result in misclassification of patients, rework and delays, and suboptimal management. The College of American Pathologists (CAP) has produced evidence-based checklists of essential pathologic parameters that are recommended to be included in cancer resection pathology reports. These checklists have been endorsed as a voluntary standard by National Quality Forum (NQF) and are considered the reporting standard by the Commission on Cancer (CoC) of the American College of Surgeons (ACS).

The CAP recently conducted a structured audit of breast cancer pathology report adequacy at 86 institutions. Overall, 35% of eligible reports were missing at least one of the ten CAP-recommended breast cancer elements. Cancer Care Ontario (CCO) conducted a similar study in 2005 and found that 25% of breast cancer pathology reports did not include all of the information required by the CAP standards.

While the exact percentage of breast cancer resection pathology reports that are missing the pT category, the pN category and the histologic grade is unknown, these are essential elements in breast cancer treatment decisions and should be included in every pathology report when possible.*

*The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure:

Patient management and treatment guidelines promote an organized approach to providing quality care. The (American College of Surgeons Commission on Cancer) CoC requires that 90% of pathology reports that include a cancer diagnosis contain the scientifically validated data elements outlined in the surgical case summary checklist of the College of American Pathologists (CAP) publication Reporting on Cancer Specimens.

All invasive breast carcinomas, with the exception of medullary carcinoma should be graded. The grading system used must be specified in the report; the Nottingham combined histologic grade (Elston-Ellis modification of Scarff-Bloom-Richardson grading system) is recommended. Within each stage grouping there is a relation between histologic grade and outcome.

TNM staging information is included in factors proven to be of prognostic import and useful in clinical patient management.

PRIMARY CLINICAL COMPONENT

Breast cancer; pathology; breast cancer resection; pathology reports (pT category [primary tumor], the pN category [regional lymph nodes] and the histologic grade)

DENOMINATOR DESCRIPTION

All breast cancer resection pathology reports (excluding biopsies) (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

NUMERATOR DESCRIPTION

Reports that include the pT category, the pN category and the histologic grade

Evidence Supporting the Measure

EVIDENCE SUPPORTING THE CRITERION OF QUALITY

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence

Evidence Supporting Need for the Measure

NEED FOR THE MEASURE

Unspecified

State of Use of the Measure

STATE OF USE

Current routine use

CURRENT USE

Internal quality improvement
National reporting

Application of Measure in its Current Use

CARE SETTING

Hospitals
Physician Group Practices/Clinics

PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Individual Clinicians

TARGET POPULATION AGE

Unspecified

TARGET POPULATION GENDER

Either male or female

STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

Characteristics of the Primary Clinical Component

INCIDENCE/PREVALENCE

Unspecified

ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

BURDEN OF ILLNESS

Unspecified

UTILIZATION

Unspecified

COSTS

Unspecified

Institute of Medicine National Healthcare Quality Report Categories

IOM CARE NEED

Getting Better

IOM DOMAIN

Effectiveness

Data Collection for the Measure

CASE FINDING

Users of care only

DESCRIPTION OF CASE FINDING

All breast cancer resection pathology reports (excluding biopsies)

DENOMINATOR SAMPLING FRAME

Patients associated with provider

DENOMINATOR INCLUSIONS/EXCLUSIONS

Inclusions
All breast cancer resection pathology reports (excluding biopsies)

Exclusions
Documentation of medical reason(s) for not including the pT category, the pN category or the histologic grade (e.g., re-excision without residual tumor; non-carcinomas)

RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the numerator

DENOMINATOR (INDEX) EVENT

Diagnostic Evaluation

DENOMINATOR TIME WINDOW

Time window is a single point in time

NUMERATOR INCLUSIONS/EXCLUSIONS

Inclusions
Reports that include the pT category, the pN category and the histologic grade

Exclusions
None

MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

NUMERATOR TIME WINDOW

Encounter or point in time

DATA SOURCE

Administrative data
Medical record

LEVEL OF DETERMINATION OF QUALITY

Individual Case

PRE-EXISTING INSTRUMENT USED

Unspecified

Computation of the Measure

SCORING

Rate

INTERPRETATION OF SCORE

Better quality is associated with a higher score

ALLOWANCE FOR PATIENT FACTORS

Unspecified

STANDARD OF COMPARISON

Internal time comparison

Evaluation of Measure Properties

EXTENT OF MEASURE TESTING

Unspecified

Identifying Information

ORIGINAL TITLE

Measure #1: breast cancer resection pathology reporting pT category (primary tumor) and pN category (regional lymph nodes) with histologic grade.

MEASURE COLLECTION

MEASURE SET NAME

SUBMITTER

American Medical Association on behalf of the College of American Pathologists and Physician Consortium for Performance Improvement®

DEVELOPER

College of American Pathologists
Physician Consortium for Performance Improvement®

FUNDING SOURCE(S)

Unspecified

COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

David L. Witte, MD, PhD, FCAP (Co-Chair); Susan R. Snyder, PhD, MBA (Co-Chair); Nancy Baxter, MD, PhD; Joel V. Brill, MD, AGAF, FACG, CHCQM; Patrick Fitzgibbons, MD, FCAP; M. Kay Washington, MD, PhD, FCAP; Mario Gonzalez, MD, FCAP, FASCP; Richard M Gore, MD, FACR; Dana Marie Grzybicki, MD, PhD; Harvey W. Kaufman, MD, FCAP; Jonathon Myles, MD, FCAP; Raouf E. Nakhleh, MD, FCAP; Omar Yousef, MD, FCAP

Robert H Haralson III, MD, MBA, American Academy Of Orthopaedic Surgeons

Kristen McNiff, MPH, American Society of Clinical Oncology; John Rainey, MD, American Society of Clinical Oncology

Alison L. Laidley, MD, FACS, FRCS(C), American College of Surgeons; Courtney H. Maggiulli, American College of Surgeons; Guy Orangio, MD, FACS, American College of Surgeons

Karen Kmetik, PhD, American Medical Association; Beth Tapper, MA, American Medical Association

Sylvia Publ, MBA, RHIA, Centers for Medicare & Medicaid Services

Lynn Boyd, College of American Pathologists; Fay Shamanski, PhD, College of American Pathologists

Felicia Nicholson, RN, BSN, Health Plan Representative

Rebecca Kresowik, Consortium Consultant; Timothy F. Kresowik, MD, Consortium Consultant

FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

Conflicts, if any, are disclosed in accordance with the Physician Consortium for Performance Improvement® conflict of interest policy.

ENDORSER

National Quality Forum

INCLUDED IN

Ambulatory Care Quality Alliance
Physician Quality Reporting Initiative

ADAPTATION

Measure was not adapted from another source.

RELEASE DATE

2007 May

MEASURE STATUS

This is the current release of the measure.

SOURCE(S)

  • College of American Pathologists (CAP), Physician Consortium for Performance Improvement®. Pathology physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2007 May. 12 p. [4 references]

MEASURE AVAILABILITY

NQMC STATUS

This NQMC summary was completed by ECRI Institute on November 3, 2008. The information was verified by the measure developer on December 4, 2008.

COPYRIGHT STATEMENT

© 2007 American Medical Association and College of American Pathologists. All Rights Reserved.

CPT® Copyright 2006 American Medical Association

Disclaimer

NQMC DISCLAIMER