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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

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### 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]{.underline} 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

[The Physician Consortium for Performance Improvement® Measurement
Sets](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1997&doc=178)

#### MEASURE SET NAME

[Pathology Physician Performance Measurement
Set](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1997&doc=11475)

#### 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

The individual measure, \"Measure #1: Breast Cancer Resection Pathology
Reporting pT Category (Primary Tumor) and pN Category (Regional Lymph
Nodes) with Histological Grade,\" is published in the \"Pathology
Physician Performance Measurement Set.\" This document and technical
specifications are available in Portable Document Format (PDF) from the
American Medical Association (AMA)-convened Physician Consortium for
Performance Improvement® Web site:
[www.physicianconsortium.org](http://www.physicianconsortium.org/).

For further information, please contact AMA staff by e-mail at
<cqi@ama-assn.org>.

#### 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

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© 2009 National Quality Measures Clearinghouse

Date Modified: 1/5/2009