Navigator Identification of Breast Biopsy Results: A Time Analysis of Biopsy Results and Variance in Turnaround Time

Objective: To improve the turnaround time of breast cancer biopsy pathology to maximize patient care. This includes:

• Interval between date biopsy performed and initial result showing type of breast cancer
• Interval between date biopsy performed and biomarker results
• Interval between date biopsy performed and fluorescence in situ hybridization (FISH) test

Methods: The study was conducted by the nurse navigator at Sarah Cannon Cancer Institute at Research Medical Center in Kansas City, a member of the oncology service-line for HCA. Nurse navigators are exposed to many processes in the cancer care system and recognize when systems are not at optimal functioning. In this study, 25 female patients who had biopsies derived from US-guided, stereotactic, and MRI-guided methods were randomly chosen over a 6-month time frame. All biopsies were performed by an interventional radiologist. Of the 25 patients, 23 had biomarkers, and 7 were required to have FISH testing. These patients included all race, religion, and age groups.

Results: The average interval for the initial biopsy results was 1.88 days, with the longest interval being 5 days and the shortest 1 day.

The average interval between the initial biopsy result and the biomarker result was 6.21 days, with the longest interval being 11 days and the shortest 2 days. The average interval between the initial biopsy result and FISH results were 11.14 days, with the longest interval being 14 days and the shortest 7 days.

Conclusions: The division has a monthly Pathology Steering Committee meeting between our pathology lab and our lab director and/or Sarah Cannon physicians. Our director brought these results to the meeting along with 2 of our breast specialist physicians to establish turnaround expectations and identify barriers in the current process. Numerous factors inherent to analyzing pathology specimens (eg, weekends, holidays, number of slides, consultations with other pathologists, etc) can factor into timely reporting.¹ Several internal processes at this pathology lab that caused undue delay were examined, as well as identifying lack of “reflex” biomarker and FISH testing for positive breast biopsy specimens. Modifications were adopted, and continued monitoring of delays with additional adjustments implemented.

Maximizing turnaround time on biopsy results ultimately lead to better and faster patient care. Navigators are frontline touchpoints to identify deficiencies in the system.

Reference

1. Patel S, Smith JB, Kurbatova E, et al. Factors that impact turnaround time of surgical pathology specimens in an academic institution. Hum Pathol. 2012;43:1501-1505.