FREQUENTLY ASKED QUESTIONS
The frequently asked questions about the Mastery of Breast Surgery Pilot Program, a Continuing Quality Improvement Initiative, are grouped together under five headings:
A. Program Requirements
B. Case Submission
C. Quality Measure #1 – Needle biopsy prior to surgery
D. Quality Measure #2 – Specimen orientation
E. Quality Measure #3 – Intraoperative confirmation of removal of non-palpable lesions
For more information, please refer to the document “Background/History” of the Mastery of Breast Surgery Pilot Program. Please do not hesitate to contact us if you need further assistance.
A. PROGRAM REQUIREMENTSTOP OF PAGE
1. Do I enter every breast surgical case?
Yes, the program is designed for you to enter ALL of your consecutive open breast surgical cases, whether benign or malignant. We expect that, once you are registered, you will enter all the open surgical cases that you do from registration date forward. We expect that you will enter ALL your open surgical cases, and not just selective, for continuous participation in the program. When you enter the patient's name, DOB and Date of Procedure, the next entry is entitled "Procedure". There is a drop down menu that lists numerous breast surgical procedures for BOTH benign and malignant disease.
Please go to the ASBS website and click on the Mastery of Breast Surgery at the left of the site. There is a document that outlines what is expected of you. Also please click on the link at the end of the document for additional information. The background and history of the program is also on the Mastery website under "Tools".
2. Is there a minimum number of cases required to participate?
It is expected that you enter data on ALL of your breast surgical cases. There is no volume requirement as the program is open to all individual surgeons who treat breast disease patients regardless of practice type.
3. Am I expected to continue to enter cases after the first 3 months?
Yes, you are expected to participate on a continuing basis by entering data on all of your breast cases.
4. Does it matter where I do my breast surgery, such as in my office or the hospital or outpatient operating room?
No, enter every open surgical breast case regardless of the location of the surgery.
5. Do I enter a vascular access case on my breast surgical patient?
No, do not enter this case because it is not a quality measure at this time. If you want to enter a vascular access case, you may select “Other” under the drop-down procedure menu and describe the procedure.
6. Can international non-members participate in the Mastery of Breast Surgery Program?
International Society members may participate in the program at no cost. International non-members will need to pay a fee of $295 or submit a membership application to the Society and pay membership dues. While all surgeons may submit cases, only those surgeons meeting the eligibility requirements for the program will receive a Certificate of Participation.
B. CASE SUBMISSIONTOP OF PAGE
7. I have a concern about submitting the cases with the patient's name and date of birth.
In the enter case screen, the patient’s first and last names are required fields. However, you may enter “X” and “Y” (or any other identifier of your choosing) in the fields if you do not wish to include the patient’s name. Please be aware that you and the site administrator are the only people who will be able to view the patient’s name.
The date of birth is also a required field on the enter case screen. To maintain data integrity, we will need the accurate date of birth for the patient.
8. Am I expected to get the patient's permission or IRB approval to participate in the program?
It is not required by the Society to obtain IRB approval or patient permission to participate in the program. Only you and the site administrator have access to the patient information. All other access is de-identified to protect the confidentiality of the participant and the patient.
9. Do I enter benign breast surgical cases?
Yes, any open surgical breast case whether benign or malignant needs to be entered.
10. What if I do not see the breast procedure in the drop down menu?
Use the option “Other” and describe your procedure in the Comment box.
11. How do I enter bilateral cases or multiple procedures on the same patient?
Enter the case multiple times, one for each procedure. You can use a unique identifier beside the Medical Record number, such as R for right and L for left.
12. How do I enter prophylactic mastectomy cases?
We encourage participants to enter all open surgical breast cases. We suggest that for prophylactic mastectomy cases select "Total mastectomy or Total Mastectomy and SLN only” under procedure on the enter case screen of the website.
For the first quality measure: Was a needle biopsy performed to evaluate the targeted lesion at some time prior to this procedure? If the decision to proceed to surgery was made based on a needle biopsy and a mastectomy for cancer was performed on one side, and a prophylactic mastectomy on the other side, then the answer would be yes. If the prophylactic mastectomy was performed for other reasons, such as high risk, and a needle biopsy was not performed the answer would be no. Under if not, why not, select "Other" and state the reason as prophylactic mastectomy in the box.
For the second quality measure: Was the surgical specimen oriented ? If you routinely place a suture or tag to orient the mastectomy specimen for the pathologist, then answer “yes”, if not, answer “no.”
For the third quality measure: If a non-palpable lesion was localized with image guidance, was there intraoperative confirmation of its removal? Answer “no” and in the drop down menu choose “Patient had a mastectomy.”
13. What if I operate on a patient more than one time, for example, for positive margins or for completion mastectomy?
Each time you take your patient for an open surgical breast procedure, you need to enter the case. For example, if you repeat the lumpectomy because of positive margins, enter the case. If breast conservation fails and you perform mastectomy, then enter the case.
C. QUALITY MEASURE #1 – NEEDLE BIOPSY PRIOR TO SURGERYTOP OF PAGE
14. If a needle biopsy was done prior to the surgical procedure, does it have to be done by me?
No, another physician, such as another surgeon or radiologist, could do the needle biopsy.
15. What if the needle biopsy was non-diagnostic, or discordant with imaging findings and I need to do surgery? How do I enter that open surgical case?
Enter yes, needle biopsy done prior to surgery. The quality measure is that the needle biopsy was performed prior to the decision for surgery.
16. How do I answer the question about needle biopsy prior to making the diagnosis on a patient with multiple procedures?
If a needle biopsy was performed to make a diagnosis that necessitated any part of the surgery, then answer, “Yes”. If a needle biopsy was not done, then answer “No”.
17. Do I enter needles biopsies as separate cases in the program?
No, you do not enter the minimally invasive procedures that you perform. The program at this time is designed for open surgical cases; however, needle biopsy is a quality measure that is reported
D. QUALITY MEASURE #2 – SPECIMEN ORIENTATIONTOP OF PAGE
18. How do I orient the specimen?
You can orient the specimen in accordance with your hospital pathology protocol. Some common ways are suture ligatures or multiple colors on the specimen or separate shaved margins from the cavity.
19. What if the pathologist orients the specimen? Is that acceptable?
Only if the pathologist receives the specimen from the operating room and can appropriately orient it. As long as the specimen is oriented, it does not matter how it is done or who does it.
E. QUALITY MEASURE #3 – INTRAOPERATIVE CONFIRMATION OF REMOVAL OF NON- PALPABLE LESIONSTOP OF PAGE
20. What if I use ultrasound to guide the breast surgery, but no wire is placed? Is this considered “with image guidance”?
As long as some form of imaging is used to localize and guide the excision that would be considered “image guidance” and a wire does not need to be placed.
21. Is a specimen radiograph necessary for intraoperative confirmation of the lesion?
Intraoperative confirmation of excision of the lesion can be done by specimen radiograph, intraoperative ultrasound, palpation of the lesion, immediate serial sectioning by the pathologist, or direct visualization of the biopsy site by the surgeon. If the target lesion is a cluster of microcalcifications, then a specimen radiograph MUST be done to confirm calcifications.