Morrow Monica, Hawley Sarah T, McLeod M Chandler, Hamilton Ann S, Ward Kevin C, Katz Steven J, Jagsi Reshma
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA.
Ann Surg Oncol. 2017 Jul;24(7):1889-1896. doi: 10.1245/s10434-017-5840-4. Epub 2017 Mar 22.
Usage of magnetic resonance imaging (MRI) in newly diagnosed breast cancer patients is increasing, despite scant evidence that it improves outcomes. Little is known about the knowledge, perspectives, and clinical characteristics of surgeons associated with MRI use.
Women with early-stage breast cancer undergoing definitive surgery between July 2013 and August 2015 were identified from the Los Angeles and Georgia Surveillance, Epidemiology and End Results (SEER) registries and were asked to name their attending surgeons. The 489 surgeons were sent a questionnaire; 77% (n = 377) responded. Questions that addressed the likelihood of ordering an MRI in different scenarios were used to create a scale to measure surgeon propensity for MRI use. Knowledge and practice characteristics also were assessed.
Mean surgeon age was 54 years, 25% were female, and median number of years in practice was 21. Wide MRI use variation was observed, with 26% obtaining MRI for a clinical stage I screen-detected breast cancer and 72% for infiltrating lobular cancer. High users of MRI were significantly more likely to be higher-volume surgeons (p < 0.001) and to have misconceptions about MRI benefits (p < 0.001). Of surgeons who felt they used MRI more often, 60% were high MRI users; only 6% were low MRI users.
Our findings suggest relatively frequent use of MRI, even in uncomplicated clinical scenarios, in the absence of evidence of benefit, and use was more common among high-volume surgeons. A substantial number of surgeons who are high MRI users harbor misconceptions about MRI benefit, suggesting an opportunity for education and consensus building regarding appropriate use.
尽管几乎没有证据表明磁共振成像（MRI）能改善新诊断乳腺癌患者的治疗结果，但该技术在这类患者中的使用仍在增加。对于与MRI使用相关的外科医生的知识、观点和临床特征，我们知之甚少。
从洛杉矶和佐治亚州的监测、流行病学和最终结果（SEER）登记处识别出2013年7月至2015年8月期间接受根治性手术的早期乳腺癌女性患者，并要求她们说出其主治外科医生的名字。向489名外科医生发送了调查问卷；77%（n = 377）做出了回应。通过询问在不同情况下开具MRI检查的可能性的问题来创建一个量表，以衡量外科医生使用MRI的倾向。同时也评估了他们的知识和实践特征。
外科医生的平均年龄为54岁，25%为女性，从业年限中位数为21年。观察到MRI使用存在很大差异，26%的医生会为临床I期筛查发现的乳腺癌患者进行MRI检查，72%的医生会为浸润性小叶癌患者进行该检查。MRI高使用者更有可能是手术量较大的外科医生（p < 0.001），并且对MRI的益处存在误解（p < 0.001）。在认为自己更频繁使用MRI的外科医生中，60%是MRI高使用者；只有6%是低使用者。
我们的研究结果表明，即使在没有益处证据的情况下，MRI在无并发症的临床情况下也使用得相对频繁，并且在手术量较大的外科医生中使用更为普遍。相当一部分MRI高使用量的外科医生对MRI的益处存在误解，这表明有必要就合理使用进行教育并达成共识。
