Zhang Michelle, Sun Simon, Mesurolle Benoît
Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 1001 Boulevard Decarie, Montreal, Quebec, Canada.
PLoS One. 2017 Jan 9;12(1):e0169756. doi: 10.1371/journal.pone.0169756. eCollection 2017.
To assess the impact of pre-operative breast MRI on surgical waiting time, and to identify factors contributing to the delay.
A retrospective cohort study involving 1274 patients was conducted after obtaining institutional ethics review. Surgical candidates for newly diagnosed breast cancer from 2007 to 2013 at a tertiary center were divided into 2 groups: those who had pre-operative MRI and those who did not. Linear regression using matched populations was used to compare the surgical waiting times, defined as time from the date of the first positive biopsy to the date of surgery. Potential influences on surgical waiting time and subgroup analysis were obtained using median regression analysis and the Kruskal-Wallis test.
Mean surgical waiting time was 57.9 days (95% CI: 55.6-60.1) for MRI patients, compared to 46.8 days (95% CI: 45.1-48.9) for the control group, after matching for potential confounding factors (p<0.0001). Increased surgical waiting time was associated with more favorable pathology, later year of diagnosis, older patient age, surgeon and summer time. Second-look ultrasound and subsequent biopsies were associated with increased waiting time (p = 0.001).
Pre-operative breast MRI increased surgical waiting time by 11 days using a conventional average of differences, and by 12 days after using a full matching statistical method (p<0.0001), with the main contributor being additional post-MRI procedures and imaging.
评估术前乳腺磁共振成像（MRI）对手术等待时间的影响，并确定导致延迟的因素。
在获得机构伦理审查后，进行了一项涉及1274例患者的回顾性队列研究。将2007年至2013年在一家三级中心新诊断乳腺癌的手术候选者分为两组：进行术前MRI检查的患者和未进行术前MRI检查的患者。使用匹配人群的线性回归来比较手术等待时间，手术等待时间定义为从首次活检阳性日期到手术日期的时间。使用中位数回归分析和Kruskal-Wallis检验获得对手术等待时间的潜在影响及亚组分析结果。
在对潜在混杂因素进行匹配后，MRI检查患者的平均手术等待时间为57.9天（95%置信区间：55.6 - 60.1），而对照组为46.8天（95%置信区间：45.1 - 48.9）（p<0.0001）。手术等待时间延长与更有利的病理结果、诊断年份较晚、患者年龄较大、外科医生以及夏季有关。二次超声检查和后续活检与等待时间延长有关（p = 0.001）。
使用传统的平均差异法，术前乳腺MRI使手术等待时间延长了11天，采用完全匹配统计方法后延长了12天（p<0.0001），主要原因是MRI检查后的额外程序和成像。
