Henry N Lynn, Braun Thomas M, Breslin Tara M, Gorski David H, Silver Samuel M, Griggs Jennifer J
Huntsman Cancer Institute, Salt Lake City, Utah.
University of Utah School of Medicine, Salt Lake City, Utah.
Cancer. 2017 Aug 1;123(15):2975-2983. doi: 10.1002/cncr.30674. Epub 2017 Mar 16.
Although national guidelines do not recommend extent of disease imaging for patients with newly diagnosed early stage breast cancer given that the harm outweighs the benefits, high rates of testing have been documented. The 2012 Choosing Wisely guidelines specifically addressed this issue. We examined the change over time in imaging use across a statewide collaborative, as well as the reasons for performing imaging and the impact on cost of care.
Clinicopathologic data and use of advanced imaging tests (positron emission tomography, computed tomography, and bone scan) were abstracted from the medical records of patients treated at 25 participating sites in the Michigan Breast Oncology Quality Initiative (MiBOQI). For patients diagnosed in 2014 and 2015, reasons for testing were abstracted from the medical record.
Of the 34,078 patients diagnosed with stage 0-II breast cancer between 2008 and 2015 in MiBOQI, 6853 (20.1%) underwent testing with at least 1 imaging modality in the 90 days after diagnosis. There was considerable variability in rates of testing across the 25 sites for all stages of disease. Between 2008 and 2015, testing decreased over time for patients with stage 0-IIA disease (all P < .001) and remained stable for stage IIB disease (P = .10). This decrease in testing over time resulted in a cost savings, especially for patients with stage I disease.
Use of advanced imaging at the time of diagnosis decreased over time in a large statewide collaborative. Additional interventions are warranted to further reduce rates of unnecessary imaging to improve quality of care for patients with breast cancer. Cancer 2017;123:2975-83. © 2017 American Cancer Society.
尽管国家指南不建议对新诊断的早期乳腺癌患者进行疾病范围成像检查，因为其危害大于益处，但已有文献记录了较高的检查率。2012年的“明智选择”指南特别提到了这个问题。我们研究了全州范围内合作中成像检查使用情况随时间的变化，以及进行成像检查的原因及其对护理成本的影响。
从密歇根乳腺癌肿瘤学质量倡议（MiBOQI）中25个参与站点治疗的患者病历中提取临床病理数据和先进成像检查（正电子发射断层扫描、计算机断层扫描和骨扫描）的使用情况。对于2014年和2015年诊断的患者，从病历中提取检查原因。
在2008年至2015年期间MiBOQI诊断为0-II期乳腺癌的34078例患者中，6853例（20.1%）在诊断后90天内接受了至少1种成像检查。所有疾病阶段的25个站点的检查率存在很大差异。在2008年至2015年期间，0-IIA期疾病患者的检查随时间减少（所有P <.001），IIB期疾病患者的检查率保持稳定（P =.10）。随着时间的推移，这种检查减少带来了成本节约，尤其是对于I期疾病患者。
在一个大型全州范围内的合作中，诊断时先进成像检查的使用随时间减少。有必要采取额外的干预措施，以进一步降低不必要成像检查的比率，从而提高乳腺癌患者的护理质量。《癌症》2017；123：2975 - 2983。© 2017美国癌症协会。
