Jekielek Maria, Nisenbaum Rosane, Vinik Ophir, Kassardjian Charles D
Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Muscle Nerve. 2025 Sep;72(3):502-508. doi: 10.1002/mus.28463. Epub 2025 Jun 28.
INTRODUCTION/AIMS: Although the need for malignancy screening in idiopathic inflammatory myopathies (IIM) is generally accepted, data to guide the choice and timing of investigations are limited. Our aim was to characterize the gaps and uncertainties amongst Canadian neurologists and rheumatologists with respect to malignancy screening in IIM.
An online survey consisting of 18 multiple-choice questions related to malignancy screening practices was distributed to adult neurologists and rheumatologists practising in Canada, and survey responses were described and compared between groups.
Of 69 participants, the majority (95.7%) performed malignancy screening. However, there was variability in practice including delegation and choice of screening tests, influence of patient-specific factors, and timing of repeat testing relative to original testing. Only 18.2% of respondents were confident in their malignancy screening practices. The most significant perceived knowledge gap was lack of consensus or guidelines on choice and frequency of malignancy screening (92.8%). Compared with neurologists, rheumatologists saw a higher number of IIM patients per year (72.5% vs. 41.4% reported five or more, p = 0.009), were more likely to consider patient risk factors and order more investigations, while neurologists were more likely to repeat testing.
Variability and knowledge gaps exist amongst neurologists and rheumatologists with regard to malignancy screening in IIM patients. The identified variability and lack of confidence may lead to lack of standardization of care, and potentially either under- or over-investigating of IIM patients for malignancy. Further research is required to better understand the optimal choice of tests and timing of repeat investigations.
引言/目的：尽管特发性炎性肌病（IIM）患者进行恶性肿瘤筛查的必要性已得到普遍认可，但指导检查选择和时机的数据有限。我们的目的是描述加拿大神经科医生和风湿病医生在IIM患者恶性肿瘤筛查方面的差距和不确定性。
向在加拿大执业的成年神经科医生和风湿病医生发放了一份包含18个与恶性肿瘤筛查实践相关的多项选择题的在线调查问卷，并对调查结果进行了描述和组间比较。
69名参与者中，大多数（95.7%）进行了恶性肿瘤筛查。然而，实践中存在差异，包括筛查测试的委托和选择、患者特定因素的影响以及相对于初次检测的重复检测时机。只有18.2%的受访者对其恶性肿瘤筛查实践有信心。最明显的认知差距是在恶性肿瘤筛查的选择和频率方面缺乏共识或指南（92.8%）。与神经科医生相比，风湿病医生每年诊治的IIM患者数量更多（72.5%的人报告诊治过5名或更多患者，而神经科医生为41.4%，p = 0.009），他们更有可能考虑患者风险因素并安排更多检查，而神经科医生更有可能进行重复检测。
神经科医生和风湿病医生在IIM患者恶性肿瘤筛查方面存在差异和知识差距。所发现的差异和信心不足可能导致护理缺乏标准化，并可能导致对IIM患者进行恶性肿瘤检查时要么检查不足要么检查过度。需要进一步研究以更好地了解检查的最佳选择和重复检查的时机。
