Reporting and Abstracting Variability in Technical Standards for Breast Cancer Operations

Area of Science:

• Oncology
• Surgical Pathology
• Healthcare Quality Improvement

Background:

• The American College of Surgeons Commission on Cancer mandates documentation of critical elements in operative standards for cancer surgery accreditation.
• This study evaluated the current documentation practices for critical elements in partial mastectomy (PM) and sentinel lymph node biopsy (SLNB) operative reports.

Purpose of the Study:

• To assess the adherence to and interobserver reliability of documenting critical elements in partial mastectomy and sentinel lymph node biopsy operative reports.
• To compare the documentation of oncologic elements with the American Society of Breast Surgeons Mastery of Breast Surgery (MBS) quality measure for specimen orientation.

Main Methods:

• A review of 66 partial mastectomy + sentinel lymph node biopsy operative reports from 2013-2018 at a single academic institution.
• Ten reviewers assessed 13 "Oncologic Elements" and one MBS measure for compliance and interrater reliability.

Main Results:

• No operative records fully documented all critical elements for partial mastectomy and sentinel lymph node biopsy procedures.
• Documentation varied significantly between resident and attending surgeons, particularly for sentinel lymph node biopsy elements.
• High reporting and reliability were observed for sentinel lymph node biopsy tracer use (97.1%) and MBS specimen orientation (87.0%), while intraoperative assessment of SLNB showed low compliance (30.6%).

Conclusions:

• Adherence to reporting critical elements for partial mastectomy and sentinel lymph node biopsy is variable.
• Clarifying synoptic reporting choices may enhance consistency in documentation.
• Continuous evaluation of mandated reporting is necessary to adapt to evolving breast surgery techniques and technologies.