Does regular quality control improve the quality of surgery in Slovenian breast cancer screening program?
, , and | May 28, 2020
About this article
Article Category: Research Article
Published Online: May 28, 2020
Page range: 488 - 494
Received: Apr 04, 2020
Accepted: Apr 26, 2020
DOI: https://doi.org/10.2478/raon-2020-0030
© 2020 Andraz Perhavec, Sara Milicevic, Barbara Peric, Janez Zgajnar, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Quality indicators of diagnostic surgical procedures split by the year of surgery
| Recommendation | All | 2016 | 2017 | 2018 | p-value | |
|---|---|---|---|---|---|---|
| 1 QI: waiting time | Not more than 15 | 41 | 44.5 | 42 | 34 | < 0.001 |
| 2 QI: weight of the excised specimen from the breast | Proportion of specimen with weigh less than 30g ≥ 90% | 37.3 ± 23.4 | 40.3 ± 25.8 | 32.6 ± 22.1 | 38.2 ± 22.1 | 0.131 |
The variability of QIs within the institution for each studying year and altogether
| All | 2016 | 2017 | 2018 | ||
|---|---|---|---|---|---|
| Number of procedures: least active surgeon - most active surgeon | 1–166 | 1–45 | 6–62 | 1–67 | |
| Proportion of mastectomies: surgeon with lowest proportion - surgeon with highest proportion | 17.8%–100.0% | 10.0%–100.0% | 12.5%–44.4% | 0.0%–100.0% | |
| Median waiting time ( in days): surgeon with lowest - surgeonwith highest waiting time | 28.0–45.0 | 24.0–45.0 | 27.0–41.0 | 23.0–136.0 | |
| Single (breast) operation for the primary tumour (excluding reconstruction): surgeon with lowest - surgeon with highest proportion | 83.1%–100.0% | 73.3%–100.0% | 71.4%–100.0% | 75.0%–100.0% | |
| Invasive breast cancer not greater than 3 cm who underwent BCT: surgeon with lowest - surgeon with highest proportion | 0.0%–92.6% | 0.0%–94.4% | 40.0%–100.0% | 77.8%–100.0% | |
| Weight (g) of the excised specimen from surgeon with lowest mean - surgeon with the breast: surgeon with lowest mean - surgeon with highest highest mean | 35.5–89.0 | 33.5–104.5 | 28.0–94.0 | 37.0–81.5 | |
| Patients with invasive cancer and axillary clearance performed with at least 10 LN examined: surgeon with lowest - surgeon with highest proportion | 71.4%–100.0% | 50.0%–100.0% | 80.0%–100.0% | 50.0%–100.0% | |
| Number active surgeon of procedures: least active surgeon - most | 3–30 | 1–12 | 1–11 | 1 -12 | |
| Median waiting time ( in days): surgeon with lowest - surgeon with highest waiting time | 25.5–45.0 | 24.0–59.0 | 28.5–76.0 | 20.0–71.0 | |
| Weight (g) of the excised specimen from the breast: surgeon with lowest mean - surgeon with highest mean | 18.0–70.0 | 22.0–73.0 | 15.0–55.0 | 18.0–94.0 |
Characteristics of therapeutic procedures performed between 2016 and 2018
| No. of procedures | All | 2016 | 2017 | 2018 | p-value |
|---|---|---|---|---|---|
| 1197 | 296 | 417 | 484 | ||
| Procedure type in breast | |||||
| BCT | 927 (77.4%) | 218 (73.6%) | 312 (74.8%) | 397 (82.0%) | 0.007 |
| mastectomies | 270 (22.6%) | 78 (26.4%) | 105 (25.2%) | 87 (18.0%) | |
| Procedure type in axilla: | |||||
| none | 202 (16.9%) | 34 (11.5%) | 72 (17.3%) | 96 (19.8%) | |
| SNB | 858 (71.7%) | 211 (71.3%) | 304 (72.9%) | 343 (70.9%) | 0.002 |
| ALND | 87 (7.3%) | 35 (11.8%) | 25 (6.0%) | 27 (5.6%) | |
| SNB + ALND | 50 (4.2) | 16 (5.4%) | 16 (3.8%) | 18 (3.7%) | |
| Histologic tumour type | |||||
| Benign | 64 (5.3%) | 6 (2.0%) | 19 (4.6%) | 39 (8.1%) | |
| | 214 (17.9%) | 50 (16.9%) | 84 (20.1%) | 80 (16.5%) | |
| Microinvasive carcinoma | 19 (1.6%) | 2 (0.7%) | 12 (2.9%) | 5 (1.0%) | 0.004 |
| Invasive carcinoma | 899 (75.1%) | 238 (80.4%) | 302 (72.4%) | 359 (74.2%) | |
| Other | 1 (0.1%) | 0 (0.0%) | 0 (0.0%) | 1 (0.2%) | |
| Mean tumour diameter ± S.D. (mm) | 17.8 ± 13.3 | 18.9 ± 14.6 | 18.2 ± 13.6 | 16.8 ± 12.0 | 0.127 |
Results of the diagnostic surgical procedures split by the year of treatment
| No. of procedures | All | 2016 | 2017 | 2018 | p-value |
|---|---|---|---|---|---|
| 224 | 78 | 66 | 80 | ||
| Procedure type in axilla: | |||||
| - none | 208 (92.9%) | 75 (96.2%) | 59 (89.4%) | 74 (92.5%) | |
| - SNB | 16 (7.1%) | 3 (3.8%) | 7 (10.6%) | 6 (7.5%) | 0.289 |
| - ALND | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | |
| - SNB + ALND | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | |
| Histologic tumour type | |||||
| - Benign | 177 (79.0%) | 63 (79.5%) | 52 (78.8%) | 62 (77.5%) | |
| | 28 (12.5%) | 11 (14.1%) | 6 (9.1%) | 11 (13.8%) | 0.610 |
| - Microinvasive carcinoma | 1 (0.4%) | 1 (1.3%) | 0 (0%) | 0 (0.0%) | |
| - Invasive carcinoma | 14 (6.3%) | 2 (2.6%) | 6 (9.1%) | 6 (7.5%) | |
| - Other malignat | 4 (1.8%) | 1 (1.3%) | 2 (3%) | 1 (1.3%) | |
| Mean tumour diameter ± S.D. (mm) | 15.5 ± 14.1 | 15.0 ± 14.1 | 19.0 ± 18.7 | 12.2 ± 5.7 | 0.701 |
Quality indicators of therapeutic surgical procedures split by the year of treatment
| Recommendation: | All | 2016 | 2017 | 2018 | p-value | |
|---|---|---|---|---|---|---|
| 1. QI: waiting time | ||||||
| Median (days) Proportion of patients with waiting time less than 15 working days | Not more than 15 working | 33 | 38 | 34 | 28 | < 0.001 |
| 2. QI: proportion of patients (invasive and noninvasive cancers) who received a single (breast) operation for the primary tumour (excluding reconstruction) | Minimum standard: 80% | 1088/1197 | 266/296 | 379/417 | 443/484 | 0.735 |
| 3. QI: proportion of patients with invasive breast cancer not greater than 3 cm (total size, including DCIS component) who underwent BCT | Minimum standard: 70% | 669/801 | 165/211 | 220/265 | 284/325 | 0.019 |
| 4. QI: proportion of patients with invasive cancer and axillary clearance performed with at least 10 LN examined | Minimum standard: 95% | 124/137 | 45/51 | 40/41 | 39/45 (86.7%) | 0.014 |
| 5. QI: weight of the excised specimen from the breast Mean ± S.D. (g) Proportion of specimens with weight ≤ 80g (%) | Proportion of specimen after BCT with weight less than 80g ≥ 90% | 69.0 ± 42.5 | 75.3 ± 50.3 | 63.8 ± 35.9 | 69.7 ± 42.3 | 0.009 |