title: Quality assurance initiative at one institution for minimally invasive breast biopsy as the initial diagnostic technique.
abstract: BACKGROUND
  In 2005, the American College of Surgeons Consensus Conference issued a statement about the diagnostic workup of image-detected breast abnormalities. Guidelines include use of image-guided percutaneous needle biopsy as the gold standard for diagnosing image-detected breast abnormalities. In this study, we evaluate a method to audit use of excisional biopsy among different breast surgeons at our institution.
  
  
  METHODS
  From March to September 2007, 465 patients undergoing breast operation for benign or malignant lesions at our institution were interviewed by a surgical resident or physician's assistant. If an excisional biopsy was scheduled for initial diagnosis, the patient and surgeon were asked whose preference it was to perform the operation. Three attending groups were designated: academic breast surgeons, private practice breast surgeons on clinical faculty, and general surgeons who perform breast operations in addition to other procedures. Use of excisional biopsy was compared between these groups.
  
  
  RESULTS
  Compliance for preoperative interview completion was 79%, differing substantially between surgeon groups with rates of 91%, 74%, and 58% for the academic breast, private practice, and general surgeons, respectively. Excisional biopsy for diagnosis made up 10%, 35%, and 37% of the case load for academic breast, private practice, and general surgeons, respectively. Patient and surgeon agreed 85% of the time for preference of performing diagnostic excisional biopsies.
  
  
  CONCLUSIONS
  Excisional biopsies continue to be performed as the initial diagnostic procedure for 40% of patients. Tracking biopsy practices by surgeon can improve adherence with current recommendations.
authors.affiliation: Department of Surgery, Beth Israel Medical Center, New York, NY, USA.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Clarke-Pearson
authors.forename: Allyson F
authors.initials: AF
authors.lastname: Jacobson
authors.forename: Susan K
authors.initials: SK
authors.lastname: Boolbol
authors.forename: I Michael
authors.initials: IM
authors.lastname: Leitman
authors.forename: Patricia
authors.initials: P
authors.lastname: Friedmann
authors.forename: Valentina
authors.initials: V
authors.lastname: Lavarias
authors.forename: Sheldon M
authors.initials: SM
authors.lastname: Feldman
mesh_terms: D001706:Biopsy / Q000379:methods / Q000592:standards*; D001707:Biopsy, Needle / Q000592:standards; D001940:Breast / Q000473:pathology*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008485:Medical Audit; D019060:Minimally Invasive Surgical Procedures / Q000592:standards; D011785:Quality Assurance, Health Care