Cedars Sinai Medical Center, 8700 Beverly Blvd Suite 5512, Los Angeles, CA 90048, USA.
Breast Cancer Res Treat. 2012 Oct;135(3):907-12. doi: 10.1007/s10549-012-2207-1. Epub 2012 Aug 26.
Rapid uptake of new imaging technology is a major contributor to rising healthcare costs. Preoperative breast magnetic resonance imaging (MRI) for patients with early-stage breast cancer has dramatically increased in use without the evidence of improved outcomes compared to standard assessment and is associated with higher rates of mastectomy. A decision analytic model was developed to evaluate the impact of adding breast MRI to the preoperative evaluation of women with early-stage breast cancer who were candidates for breast-conserving therapy on patient outcomes measured in quality-adjusted life years (QALYs). Model inputs, including survival, recurrence rates, and health utilities, were obtained from a comprehensive literature review. One-way sensitivity analyses were performed to estimate threshold values for key parameters at which adding MRI would become the optimal imaging strategy over standard assessment. Preoperative MRI resulted in 17.77 QALYs compared to 17.86 QALYs with standard assessment, a decrease of 0.09 QALYs or 34 days. In sensitivity analyses, standard assessment was associated with better patient outcomes than preoperative breast MRI across all plausible probabilities for mastectomy, local recurrence, and health utilities. For routine preoperative breast MRI to become the optimal strategy, the conversion rate to mastectomy after preoperative MRI would need to be <1 % (versus the range of 3.6-33 % reported in the literature). Routine preoperative breast MRI appears to confer no advantage over the standard diagnostic evaluations for early-stage breast cancer and may lead to worse patient outcomes.
新成像技术的快速采用是医疗保健成本上升的主要原因之一。与标准评估相比，早期乳腺癌患者术前乳房磁共振成像（MRI）的使用显著增加，但没有改善结果的证据，并且与更高的乳房切除术率相关。开发了一个决策分析模型，以评估在早期乳腺癌且适合保乳治疗的女性的术前评估中添加乳房 MRI 对患者结局（以质量调整生命年来衡量）的影响。模型输入包括生存、复发率和健康效用，这些都是从全面的文献回顾中获得的。进行了单因素敏感性分析，以估计关键参数的阈值，在这些阈值下，添加 MRI 将成为标准评估的最佳成像策略。与标准评估相比，术前 MRI 导致 17.77 个 QALYs，而标准评估导致 17.86 个 QALYs，减少了 0.09 个 QALYs 或 34 天。在敏感性分析中，在所有合理的乳房切除术、局部复发和健康效用概率下，标准评估与术前乳房 MRI 相比都与更好的患者结局相关。为了使常规术前乳房 MRI 成为最佳策略，术前 MRI 后乳房切除术的转化率需要<1%（而文献报道的范围为 3.6-33%）。常规术前乳房 MRI 似乎没有优于早期乳腺癌的标准诊断评估，并且可能导致更差的患者结局。
