Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts2Department of Medicine, Harvard Vanguard Medical Associates, Boston, Massachusetts.
JAMA Intern Med. 2014 Jan;174(1):114-21. doi: 10.1001/jamainternmed.2013.11958.
Breast magnetic resonance imaging (MRI) is highly sensitive for detecting breast cancer. Low specificity, cost, and little evidence regarding mortality benefits, however, limit recommendations for its use to high-risk women. How breast MRI is actually used in community settings is unknown.
To describe breast MRI trends and indications in a community setting.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study at a not-for-profit health plan and multispecialty group medical practice in New England of 10,518 women aged 20 years and older enrolled in the health plan for at least 1 year who had at least 1 breast MRI between January 1, 2000, and December 31, 2011.
Breast MRI counts were obtained from claims data. Clinical indication (screening, diagnostic evaluation, staging or treatment, or surveillance) was determined using a prediction model developed from electronic medical records on a subset of participants. Breast cancer risk status was assessed using claims data and, for the subset, also through electronic medical record review. RESULTS; Breast MRI use increased more than 20-fold from 6.5 per 10,000 women in 2000 to 130.7 per 10,000 in 2009. Use then declined and stabilized to 104.8 per 10,000 by 2011. Screening and surveillance, rare indications in 2000, together accounted for 57.6% of MRI use by 2011; 30.1% had a claims-documented personal history and 51.7% a family history of breast cancer, whereas 3.5% of women had a documented genetic mutation. In the subset of women with electronic medical records who received screening or surveillance MRIs, only 21.0% had evidence of meeting American Cancer Society (ACS) criteria for breast MRI. Conversely, only 48.4% of women with documented deleterious genetic mutations received breast MRI screening.
Breast MRI use increased steeply over 10 years and then stabilized, especially for screening and surveillance among women with family or personal history of breast cancer; most women receiving screening and surveillance breast MRIs lacked documented evidence of meeting ACS criteria, and many women with mutations were not screened. Efforts are needed to ensure that breast MRI use and documentation are focused on those women who will benefit most.
乳腺磁共振成像（MRI）对乳腺癌的检测具有高度敏感性。然而，其特异性低、成本高，且关于死亡率获益的证据较少，这限制了将其推荐用于高危女性。在社区环境中，乳腺 MRI 的实际应用情况尚不清楚。
描述社区环境中乳腺 MRI 的趋势和适应证。
设计、设置和参与者：在新英格兰地区的一个非营利性健康计划和多专科医疗集团中，对至少 1 年参加健康计划且在 2000 年 1 月 1 日至 2011 年 12 月 31 日期间至少进行过 1 次乳腺 MRI 的 10518 名 20 岁及以上女性进行了回顾性队列研究。
从理赔数据中获取乳腺 MRI 计数。临床适应证（筛查、诊断评估、分期或治疗或监测）使用从部分参与者的电子病历中开发的预测模型确定。使用理赔数据评估乳腺癌风险状况，对于部分参与者，还通过电子病历审查进行评估。
从 2000 年每 10000 名女性 6.5 次乳腺 MRI 增加到 2009 年的 130.7 次，乳腺 MRI 的使用增加了 20 多倍。随后，使用率下降并在 2011 年稳定在每 10000 名女性 104.8 次。筛查和监测，2000 年是罕见的适应证，到 2011 年已占 MRI 使用率的 57.6%；30.1%有理赔记录的个人乳腺癌史，51.7%有家族乳腺癌史，而 3.5%的女性有记录的遗传突变。在有电子病历的接受筛查或监测 MRI 的女性亚组中，仅有 21.0%有证据符合美国癌症协会（ACS）的乳腺 MRI 标准。相反，仅有 48.4%有记录的有害基因突变的女性接受了乳腺 MRI 筛查。
乳腺 MRI 的使用在 10 年内急剧增加，然后稳定下来，尤其是在有家族或个人乳腺癌史的女性中进行筛查和监测；大多数接受筛查和监测乳腺 MRI 的女性缺乏符合 ACS 标准的记录证据，许多有突变的女性未接受筛查。需要努力确保乳腺 MRI 的使用和记录侧重于最受益的女性。
