Hahn Erin E, Tang Tania, Lee Janet S, Munoz-Plaza Corrine, Adesina Joyce O, Shen Ernest, Rowley Braden, Maeda Jared L, Mosen David M, Ruckdeschel John C, Gould Michael K
Kaiser Permanente Southern California, Pasadena; Southern California Permanente Medical Group, Los Angeles, CA; Intermountain Healthcare, Salt Lake City, UT; Mid-Atlantic Permanente Research Institute, Rockville, MD; and Kaiser Permanente Center for Health Research, Portland, OR
Kaiser Permanente Southern California, Pasadena; Southern California Permanente Medical Group, Los Angeles, CA; Intermountain Healthcare, Salt Lake City, UT; Mid-Atlantic Permanente Research Institute, Rockville, MD; and Kaiser Permanente Center for Health Research, Portland, OR.
J Oncol Pract. 2015 May;11(3):e320-8. doi: 10.1200/JOP.2014.002998. Epub 2015 Apr 21.
Advanced imaging is commonly used for staging of early-stage breast cancer, despite recommendations against this practice. The objective of this study was to evaluate and compare use of imaging for staging of breast cancer in two integrated health care systems, Kaiser Permanente (KP) and Intermountain Healthcare (IH). We also sought to distinguish whether imaging was routine or used for diagnostic purposes.
We identified patients with stages 0 to IIB breast cancer diagnosed between 2010 and 2012. Using KP and IH electronic health records, we identified use of computed tomography, positron emission tomography, or bone scintigraphy 30 days before diagnosis to 30 days postsurgery. We performed chart abstraction on a random sample of patients who received a presurgical imaging test to identify indication.
For the sample of 10,010 patients, mean age at diagnosis was 60 years (range, 22 to 99 years); with 21% stage 0, 47% stage I, and 32% stage II. Overall, 15% of patients (n = 1,480) received at least one imaging test during the staging window, 15% at KP and 14% at IH (P = .5). Eight percent of patients received imaging before surgery, and 7% postsurgery. We found significant intraregional variation in imaging use. Chart abstraction (n = 129, 16% of patients who received presurgical imaging) revealed that 48% of presurgical imaging was diagnostic.
Use of imaging for staging of low-risk breast cancer was similar in both systems, and slightly lower than has been reported in the literature. Approximately half of imaging tests were ordered in response to a sign or symptom.
尽管有不建议使用的相关建议，但高级成像技术仍常用于早期乳腺癌的分期。本研究的目的是评估和比较在两个综合医疗保健系统，即凯撒医疗集团（KP）和山间医疗保健公司（IH）中，成像技术用于乳腺癌分期的情况。我们还试图区分成像检查是常规进行的还是用于诊断目的。
我们确定了2010年至2012年间诊断为0至IIB期乳腺癌的患者。利用KP和IH的电子健康记录，我们确定了从诊断前30天到术后30天期间计算机断层扫描、正电子发射断层扫描或骨闪烁显像的使用情况。我们对接受术前成像检查的患者随机样本进行病历摘要分析以确定其指征。
对于10010例患者的样本，诊断时的平均年龄为60岁（范围为22至99岁）；其中0期占21%，I期占47%，II期占32%。总体而言，15%的患者（n = 1480）在分期窗口期接受了至少一次成像检查，KP为15%，IH为14%（P = 0.5）。8%的患者在手术前接受成像检查，7%在术后接受。我们发现成像技术的使用在区域内存在显著差异。病历摘要分析（n = 129，占接受术前成像检查患者的16%）显示，48%的术前成像检查是用于诊断的。
在这两个系统中，低风险乳腺癌分期成像技术的使用情况相似，且略低于文献报道水平。大约一半的成像检查是因体征或症状而安排的。
