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Research methods
Research
Sensitivity and specificity of breast cancer ICD-9-CM codes in three Italian administrative healthcare databases: a diagnostic accuracy study
  1. Iosief Abraha1,2,
  2. Diego Serraino3,
  3. Alessandro Montedori1,
  4. Mario Fusco4,
  5. Gianni Giovannini1,
  6. Paola Casucci5,
  7. Francesco Cozzolino1,
  8. Massimiliano Orso1,
  9. Annalisa Granata5,
  10. Marcello De Giorgi5,
  11. Paolo Collarile6,
  12. Rita Chiari7,
  13. Jennifer Foglietta7,
  14. Maria Francesca Vitale4,
  15. Fabrizio Stracci8,
  16. Walter Orlandi9,
  17. Ettore Bidoli3
  18. The D.I.V.O. Group
    1. 1 Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
    2. 2 Innovation and Development, Agenzia Nazionale per i Servizi Sanitari Regionali (Age.Na.S.), Rome, Italy
    3. 3 Cancer Epidemiology Unit, Centro di Riferimento Oncologico Aviano, Aviano, Italy
    4. 4 Registro Tumori Regione Campania, ASL Napoli 3 Sud, Brusciano, Italy
    5. 5 Health ICT Service, Regional Health Authority of Umbria, Perugia, Italy
    6. 6 SOC Epidemiologia Oncologica, Centro di Riferimento Oncologico Aviano, Aviano, Italy
    7. 7 Dipartimento di Oncologia, Azienda Ospedaliera Perugia, Perugia, Italy
    8. 8 Public Health Department, University of Perugia, Perugia, Italy
    9. 9 Direzione Sanità, Regional Health Authority of Umbria, Perugia, Italy
    1. Correspondence to Dr Alessandro Montedori; amontedori{at}regione.umbria.it

    Abstract

    Objectives To assess the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in identifying patients diagnosed with incident carcinoma in situ and invasive breast cancer in three Italian administrative databases.

    Design A diagnostic accuracy study comparing ICD-9-CM codes for carcinoma in situ (233.0) and for invasive breast cancer (174.x) with medical chart (as a reference standard). Case definition: (1) presence of a primary nodular lesion in the breast and (2) cytological or histological documentation of cancer from a primary or metastatic site.

    Setting Administrative databases from Umbria Region, Azienda Sanitaria Locale (ASL) Napoli 3 Sud (NA) and Friuli VeneziaGiulia (FVG) Region.

    Participants Women with breast carcinoma in situ (n=246) or invasive breast cancer (n=384) diagnosed (in primary position) between 2012 and 2014.

    Outcome measures Sensitivity and specificity for codes 233.0 and 174.x.

    Results For invasive breast cancer the sensitivities were 98% (95% CI 93% to 99%) for Umbria, 96% (95% CI 91% to 99%) for NA and 100% (95% CI 97% to 100%) for FVG. Specificities were 90% (95% CI 82% to 95%) for Umbria, 91% (95% CI 83% to 96%) for NA and 91% (95% CI 84% to 96%) for FVG.

    For carcinoma in situ the sensitivities were 100% (95% CI 93% to 100%) for Umbria, 100% (95% CI 95% to 100%) for NA and 100% (95% CI 96% to 100%) for FVG. Specificities were 98% (95% CI 93% to 100%) for Umbria, 86% (95% CI 78% to 92%) for NA and 90% (95% CI 82% to 95%) for FVG.

    Conclusions Administrative healthcare databases from Umbria, NA and FVG are accurate in identifying hospitalised news cases of carcinoma of the breast. The proposed case definition is a powerful tool to perform research on large populations of newly diagnosed patients with breast cancer.

    • sensitivity and specificity
    • administrative database
    • validity
    • breast cancer

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

    https://doi.org/10.1136/bmjopen-2017-020627

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      Footnotes

      • Contributors AM, IA, MF and DS conceived the original idea of the study. IA, DS, AM, MF, EB, GG, FC, MO and WO designed the study. PCa, MDG, PCo, AG, MFV and VC identified the cohort using administrative database with the supervision of WO, EB, DS, MF, AM and FS. IA, FC, MO, AG, PCo, VC, MFV and JF undertook the data abstraction with the supervision of AM, GG, WO, FS, MF, EB, RC and DS. IA, RC, AM and JF performed case ascertainment. IA, AM, FC, EB, MF, PE and MO performed the analysis. DS, GG, PCa, AG, MDG, PCo, RC, JF, MFV, FS, EB and WO helped in the interpretation of the data.The initial draft of the manuscript was prepared by IA, AM, FC and MO. DS, EB, GG, PCa, AG, MDG, PCo, RC, JF, MFV, FS and WO revised critically the manuscript for important intellectual content. All the authors read and approved the final manuscript. AM, MF and EB are the guarantors of the data for the respective operative units.

      • Funding This study was developed within the D.I.V.O. project (Realizzazione di un Database Interregionale Validato per l’Oncologia quale strumento di valutazione di impatto e di appropriatezza delle attività di prevenzione primaria e secondaria in ambito oncologico) supported by funding from the National Centre for Disease Prevention and Control (CCM 2014), Ministry of Health, Italy.

      • Competing interests None declared.

      • Patient consent Not required.

      • Ethics approval Ethical approval for the present study was obtained from the Ethics Committee of the Umbria Region Health Authority (CEAS).

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data sharing statement No additional data are available.

      • Collaborators David Franchini; Giuliana Alessandrini; Roberto Cirocchi; Valerio Ciullo; Michele Gobbato; Paolo Eusebi; Chiara Grisci.