Each year, members of the Cancer Committee at Rutherford Regional Health System perform several studies that help identify issues and improve the quality of patient centered cancer care at the hospital. The goal of each study is to ensure that we are providing the best care for the patients in our community. This year, our goal was to examine our process of needle localization for removal of breast cancer and to identify any areas that could be improved and to ensure those improvements were implemented.
Needle localization is a procedure performed by radiologists immediately before the surgical excision of breast cancer. It allows the surgeons to exactly target the area that needs to be removed while preserving more normal breast tissue. In 2017, we performed 28 needle localization procedures and 93% of the procedures resulted in removal of the lesion of interest. Confirmation of removal of the clip that marks the area that contains the cancer occurred in 86% of the procedures. Approximately half of the procedures were performed with ultrasound and half with mammographic guidance. There was no difference in success rate between ultrasound and mammographic guidance.
We always strive for perfection. Our goal is to be successful 100% of the time. Since we did not achieve this goal in 2017, a comprehensive review of the procedure was performed in 2018. This involved discussion of technique with the radiologists and with our surgeons. We were able to identify areas that could result in improvement.
1) Clip placement during ultrasound biopsies was an area that we felt could be improved. Previously, some biopsies were done with a small needle. The disadvantage was that it made the clip placement potentially difficult because the needle for clip placement was larger than that used for biopsy. Matching the size of the biopsy needle with the clip placement needle may allow for a more accurate placement of the clip in the biopsy site.
2) In reviewing the entire procedure with the surgeons, it was discovered that they did not always have the images of the breast available to them during the surgery. A simple process change made sure that the localization images would be displayed on the monitors in the operating suite, allowing for real time assessment of the images by the surgeons during the surgery.
3) Further discussion between the radiologists and surgeons helped ensure the position of needle placement is in the best location to assist them in removal of the target area.
4) There is increased emphasis on a discussion between the radiologist and surgeon concerning the needle placement after the procedure but before the operation begins. This can assist the surgeon in knowing exactly where the needle is with respect to the area of interest.
These changes were implemented in the beginning of 2018. A review of needle localization procedures in 2018 revealed that we had achieved our goal of 100% with 100% of lesions and clips removed.
Studies are very important to a hospital our size.Large national studies are performed and published in peer reviewed journals and allow us to confirm or modify our current practice and protocols. However, evaluating our own local performance is important to make sure we are practicing at a level that matches or ideally exceeds community standard of care.At Rutherford Regional Medical Center, we want the community to have confidence that they can receive not only compassionate care but also high quality care.