Screening and Test Evaluation Program, School of Public Health, University of Sydney, NSW 2006, Australia.
Breast. 2010 Feb;19(1):10-2. doi: 10.1016/j.breast.2009.11.005.
The routine use of pre-operative MRI in women with newly diagnosed breast cancer highlights the complexities of the use of new technology when evidence of benefit is uncertain. There are both potential harms and benefits. In the short term patients may desire and feel reassured by further testing and the use of new diagnostic techniques. However, they may also experience greater anxiety and distress from further tests and related follow-up procedures such as biopsy. In the long term MRI may result in more radical treatment decisions which are associated with poorer quality of life for women. Both patients and clinicians often (wrongly) assume that more information via testing leads to better outcomes (information bias). So how should pre-operative MRI be integrated into breast cancer care? First women need to be made aware of the uncertain evidence surrounding MRI. However whether it is appropriate to burden women with complex information and yet another decision at a time of high vulnerability and emotional distress should be considered. One potential solution is to use a Community Informed Consent approach in which a representative sample of patients and healthy women are educated about the benefits and harms and give their informed opinion about whether pre-operative MRI should be offered. Another approach is to provide patients with an evidence based decision aid to support individual informed choice. Either or a combination of both approaches would be acceptable and should be investigated. At present women are poorly informed about pre operative MRI and it is likely that they assume outcomes are be improved as a result. Clear communication about the limits of MRI to patients is needed alongside randomised trials to provide the evidence that benefit indeed outweighs the harms so that all parties involved may be comprehensively informed.
术前磁共振成像（MRI）在新诊断乳腺癌女性中的常规应用凸显了当获益证据不确定时使用新技术的复杂性。新技术的应用既有潜在危害，也有潜在益处。短期内，患者可能希望并通过进一步的检查和新的诊断技术感到安心。然而，他们也可能因为进一步的检查和相关的随访程序（如活检）而感到更大的焦虑和困扰。从长期来看，MRI 可能会导致更激进的治疗决策，从而导致女性的生活质量下降。患者和临床医生通常（错误地）认为，通过测试获得更多信息会带来更好的结果（信息偏倚）。那么，术前 MRI 应该如何融入乳腺癌的治疗呢？首先，需要让女性了解围绕 MRI 的不确定证据。然而，在高度脆弱和情绪困扰的情况下，是否应该给女性带来复杂的信息和另一个决策负担，应该加以考虑。一种潜在的解决方案是使用社区知情同意方法，即对代表性的患者和健康女性进行教育，使她们了解 MRI 的益处和危害，并就是否应提供术前 MRI 发表意见。另一种方法是为患者提供基于证据的决策辅助工具，以支持个人知情选择。这两种方法或其组合都是可以接受的，应该进行调查。目前，女性对术前 MRI 的了解甚少，她们可能认为检查结果会得到改善。需要向患者清楚地传达 MRI 的局限性，并与随机试验一起提供证据，证明获益确实超过了危害，以便所有相关方都能全面了解情况。
