Cambridge Breast Unit, Box 97, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
Br J Cancer. 2013 Jun 25;108(12):2442-7. doi: 10.1038/bjc.2013.267. Epub 2013 Jun 4.
A multidisciplinary team (MDT) approach to breast cancer management is the gold standard. The aim is to evaluate MDT decision making in a modern breast unit.
All referrals to the breast MDT where breast cancer was diagnosed from 1 July 2009 to 30 June 2011 were included. Multidisciplinary team decisions were compared with subsequent patient management and classified as concordant or discordant.
Over the study period, there were 3230 MDT decisions relating to 705 patients. Overall, 91.5% (2956 out of 3230) of decisions were concordant, 4.5% (146 out of 3230), were discordant and 4% (128 out of 3230) had no MDT decision. Of 146 discordant decisions, 26 (17.8%) were considered 'unjustifiable' as there was no additional information available after the MDT to account for the change in management. The remaining 120 discordant MDT decisions were considered 'justifiable', as management was altered due to patient choice (n=61), additional information available after MDT (n=54) or MDT error (n=5).
The vast majority of MDT decisions are implemented. Management alteration was most often due to patient choice or additional information available after the MDT. A minority of management alterations were 'unjustifiable' and the authors recommend that any patient whose treatment is subsequently changed should have MDT rediscussion prior to treatment.
多学科团队（MDT）的乳腺癌管理方法是金标准。目的是评估现代乳腺科的 MDT 决策。
纳入 2009 年 7 月 1 日至 2011 年 6 月 30 日期间在乳腺 MDT 中诊断为乳腺癌的所有转诊患者。将 MDT 决策与随后的患者管理进行比较，并分为一致或不一致。
在研究期间，共有 3230 例与 705 例患者相关的 MDT 决策。总体而言，91.5%（2956 例中有 2956 例）的决策是一致的，4.5%（146 例中有 146 例）是不一致的，4%（128 例中有 128 例）没有 MDT 决策。在 146 例不一致的决策中，26 例（17.8%）被认为是“不合理的”，因为在 MDT 之后没有额外的信息可以解释管理的变化。其余 120 例不一致的 MDT 决策被认为是“合理的”，因为管理的改变是由于患者的选择（n=61）、MDT 后获得的额外信息（n=54）或 MDT 错误（n=5）。
绝大多数 MDT 决策都得到了实施。管理改变最常是由于患者的选择或 MDT 后获得的额外信息。少数管理改变是“不合理的”，作者建议，任何随后改变治疗方案的患者在治疗前都应重新进行 MDT 讨论。
