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Clinical Assessment

Quality statement

People with early invasive breast cancer are offered a pre-treatment ultrasound evaluation of the axilla and, if abnormal lymph nodes are identified, ultrasound-guided needle biopsy (fine needle aspiration or core). Those with no evidence of lymph node involvement on needle biopsy are offered sentinel lymph node biopsy when axillary surgery is performed.

Quality measure

Structure

a) Evidence of local arrangements, including written clinical protocols, to ensure that people with early invasive breast cancer are offered a pre-treatment ultrasound of the axilla and, if abnormal lymph nodes are identified, ultrasound-guided needle biopsy (fine needle aspiration [FNA] or core).

b) Evidence of local arrangements including written clinical protocols to ensure that people with early invasive breast cancer and no evidence of lymph node involvement are offered sentinel lymph node biopsy when axillary surgery is performed.

Process

a) Proportion of people with early invasive breast cancer who receive a pre-treatment ultrasound evaluation of the axilla.

Numerator - the number of people in the denominator receiving a pre-treatment ultrasound evaluation of the axilla.

Denominator - the number of people with early invasive breast cancer.

b) Proportion of people with early invasive breast cancer who receive a pre-treatment ultrasound that identifies abnormal lymph nodes who receive an ultrasound-guided needle biopsy (FNA or core).

Numerator - the number of people in the denominator receiving an ultrasound needle biopsy (FNA or core).

Denominator - the number of people with early invasive breast cancer who receive a pre-treatment ultrasound that identifies abnormal lymph nodes.

c) Proportion of people with early invasive breast cancer and no evidence of lymph node involvement on needle biopsy who receive sentinel lymph node biopsy.

Numerator - the number of people in the denominator receiving sentinel lymph node biopsy.

Denominator - the number of people with early invasive breast cancer and no evidence of lymph node involvement on needle biopsy.

Outcome

Re-operation rates for axillary surgery.

Numerator - the number of patients in the denominator receiving more than one axillary operation to remove ipsilateral axillary lymph nodes.

Denominator - the number of patients with node-positive early invasive breast cancer who receive an axillary operation.

Description of what the quality statement means for each audience

Service providers ensure systems are in place for people with early invasive breast cancer to be offered a pre-treatment ultrasound evaluation of the axilla and, if abnormal lymph nodes are identified, ultrasound-guided needle biopsy (FNA or core). In addition, ensure systems are in place for those with no evidence of lymph node involvement to be offered sentinel lymph node biopsy when axillary surgery is performed.

Healthcare professionals ensure that people with early invasive breast cancer are offered a pre-treatment ultrasound evaluation of the axilla and, if abnormal lymph nodes are identified, ultrasound-guided needle biopsy (FNA or core). Ensure that those with no evidence of lymph node involvement are offered sentinel lymph node biopsy when axillary surgery is performed.

Commissioners ensure they commission services that provide pre-treatment ultrasound evaluation of the axilla for people with early invasive breast cancer and, if abnormal lymph nodes are identified, ultrasound-guided needle biopsy (FNA or core). Ensure services offer sentinel lymph node biopsy to those with no evidence of lymph node involvement when axillary surgery is performed.

People with early invasive breast cancerare offered an ultrasound scan of the armpit (axilla) before cancer treatment starts, to look for possible spread of the cancer to the lymph nodes. If abnormal lymph nodes are found, people are offered an ultrasound-guided needle biopsy to take a tissue sample from a lymph node. If there is no evidence of abnormal lymph nodes, people are offered another test called sentinel lymph node biopsy, which is performed during surgery for the cancer.

Source clinical guideline references

NICE clinical guideline 80, recommendations 1.1.3 and 1.4.1 (key priorities for implementation).

Data source

Structure

a) and b) Local data collection.

Process

a), b) and c) The Association of Breast Surgery (ABS) Breast Screening Audit. Available from www.cancerscreening.nhs.uk and National Cancer Dataset and Cancer Outcomes and Services Dataset (in development). Available from www.ic.nhs.uk Also contained within NICE clinical guideline 80 audit support, criteria 1 and 2. Available from www.nice.org.uk/guidance/CG80

Outcome

Local data collection.

This page was last updated: 19 January 2012

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.