乳腺磁共振成像：需要的人都能做上检查吗？

Breast magnetic resonance imaging: are those who need it getting it?

作者信息

Tan S, David J, Lalonde L, El Khoury M, Labelle M, Younan R, Patocskai E, Richard J, Trop I

机构信息

Department of Radiology.

Department of Surgery, and.

出版信息

Curr Oncol. 2017 Jun;24(3):e205-e213. doi: 10.3747/co.24.3441. Epub 2017 Jun 27.

DOI:10.3747/co.24.3441

PMID:28680288

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5486393/

Abstract

BACKGROUND

Indications for breast magnetic resonance imaging (mri), a very sensitive but less-specific tool for breast investigation, remain controversial, and accessibility is limited. The purposes of our study were to determine the proportion of breast mri exams performed for various clinical indications, to assess the wait times for breast mri, and to create a list of evidence-based indications for breast mri.

METHODS

The indications for breast mri exams performed in September 2013 at our academic centre were audited. A multidisciplinary meeting held in May 2014 established a list of evidence-based indications for breast mri, after which, in September 2014 and 2015, breast mri exams were re-audited for clinical indications, and pending requests were calculated.

RESULTS

In September 2013, surveillance of women with a prior diagnosis of breast cancer represented 21% of breast mri exams (24 of 113), with preoperative staging representing 18% of exams (20 of 113) and high-risk screening representing 12% (13 of 113). Of pending mri requests, 230 were within the recommended delay period, and 457 exceeded the recommended delay. After elaboration of evidence-based guidelines, repeat audits in September 2014 and September 2015 showed that mri performed for women with a prior breast cancer diagnosis represented 23% (33 of 141) and 7% (10 of 143) of exams respectively, with preoperative staging having declined to 9% (13 of 141) and 11% (16 of 143) of exams, and high-risk screening having increased to 36% (51 of 141) and 46% (66 of 143) of exams. Overall, wait times were improved for all breast mri indications.

CONCLUSIONS

Through multidisciplinary discussion, we actualized a list of breast mri indications, prioritized requests more adequately, and improved wait times.

摘要

背景

乳腺磁共振成像（MRI）是一种用于乳腺检查的非常敏感但特异性较低的工具，其适应证仍存在争议，且可及性有限。我们研究的目的是确定因各种临床适应证而进行的乳腺MRI检查的比例，评估乳腺MRI的等待时间，并制定一份基于证据的乳腺MRI适应证清单。

方法

对2013年9月在我们学术中心进行的乳腺MRI检查的适应证进行了审核。2014年5月召开了一次多学科会议，制定了一份基于证据的乳腺MRI适应证清单，之后，在2014年9月和2015年，对乳腺MRI检查的临床适应证进行了重新审核，并计算了待处理的请求。

结果

2013年9月，对先前诊断为乳腺癌的女性进行监测占乳腺MRI检查的21%（113例中的24例），术前分期占检查的18%（113例中的20例），高危筛查占12%（113例中的13例）。在待处理的MRI请求中，230例在推荐的延迟期内，457例超过了推荐延迟。在制定基于证据的指南后，2014年9月和2015年9月的重复审核显示，对先前诊断为乳腺癌的女性进行的MRI检查分别占检查的23%（141例中的33例）和7%（143例中的10例），术前分期已降至检查的9%（141例中的13例）和11%（143例中的16例），高危筛查已增至检查的36%（141例中的51例）和46%（143例中的66例）。总体而言，所有乳腺MRI适应证的等待时间均有所改善。