Women's Health Unit, Section of General Internal Medicine, Department of Medicine, and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA 02118, USA.
J Gen Intern Med. 2012 Jul;27(7):817-24. doi: 10.1007/s11606-011-1982-4. Epub 2012 Jan 31.
Breast pain is a common complaint to primary care and breast specialists. Literature recommends imaging to provide reassurance of benign etiology. The effect of imaging on reassurance and subsequent healthcare utilization has not been described.
To determine if initial imaging for breast pain reduces subsequent utilization.
Retrospective cohort study at a hospital-based breast health practice.
Women referred for breast pain from 2006-2009.
Imaging ordered at initial provider visit; clinical utilization, defined as the number of follow-up visits, diagnostic imaging studies, and biopsies completed within 12 months following initial visit.
Sixty-percent of women were age 40 or younger, 87% were from racial/ethnic minority groups. Twenty-five percent had imaging ordered at initial visit. Of those who received initial imaging, 75% had normal radiographic findings, yet 98% returned for additional evaluation. In adjusted analyses, women with initial imaging had increased clinical services utilization (OR 25.4, 95% CI: 16.7, 38.6). Women with normal clinical breast exams who received initial imaging exhibited increased odds for subsequent clinical services utilization (OR 23.8, 95% CI: 12.9, 44.0). Six cancers were diagnosed; imaging in the absence of clinical breast exam abnormalities did not result in any cancer identification.
Initial imaging for women with breast pain increased the odds of subsequent clinical utilization and did not increase reassurance in ruling out malignancy.
乳房疼痛是向初级保健医生和乳腺专家就诊的常见原因。文献建议进行影像学检查以提供良性病因的保证。影像学检查对保证结果和随后的医疗保健利用的影响尚未描述。
确定乳房疼痛的初始影像学检查是否减少了后续的利用。
在医院为基础的乳腺保健实践中进行的回顾性队列研究。
2006-2009 年因乳房疼痛而被转介的女性。
初始就诊时开具的影像学检查；临床利用，定义为在初始就诊后 12 个月内完成的随访就诊次数、诊断性影像学研究和活检次数。
60%的女性年龄在 40 岁或以下，87%来自种族/族裔少数群体。25%在初始就诊时开具了影像学检查。在接受初始影像学检查的患者中，75%的影像学结果正常，但 98%的患者进行了额外的评估。在调整分析中，有初始影像学检查的女性有更多的临床服务利用（OR 25.4，95%CI：16.7，38.6）。接受初始影像学检查且临床乳房检查正常的女性随后进行临床服务利用的可能性增加（OR 23.8，95%CI：12.9，44.0）。诊断出 6 例癌症；在没有临床乳房检查异常的情况下进行影像学检查并未导致任何癌症的检出。
对于乳房疼痛的女性，初始影像学检查增加了后续临床利用的几率，并且没有增加排除恶性肿瘤的保证。
