What is the optimal threshold at which to recommend breast biopsy?
What is the optimal threshold at which to recommend breast biopsy?
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DOI：
10.1371/journal.pone.0048820
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Alagoz O
中科院分区：
文献类型：
--
作者：
Burnside ES;Chhatwal J;Alagoz O
2% 的阈值传统上用作乳腺活检建议的水平，现已推广到文献中分析的几种具体情况的所有患者。我们使用考虑临床和乳房X线照相特征的序贯决策分析模型来确定图像引导乳腺活检的最佳一般阈值以及该阈值对这些特征变化的敏感性。我们建立了一个称为马尔可夫决策过程 (MDP) 模型的决策分析模型，该模型确定进行乳腺活检的乳腺癌风险的最佳阈值，以最大限度地提高患者的总质量调整生命年 (QALY)。最佳活检阈值是根据患者患乳腺癌的概率确定的，该概率是通过逻辑回归模型 (LRM) 估计的，该模型使用人口统计风险因素（年龄、家族史和激素使用）和乳房 X 光检查结果（使用已建立的词典 – BI-RADS 进行描述）。我们使用 SEER 数据（侵袭性与原位疾病的患病率、诊断阶段和生存）、美国生命表（全因死亡率）和医学文献（活检无效性和治疗效果）来估计 MDP 模型的参数，以确定乳腺活检的最佳“基本情况”风险阈值并进行敏感性分析。基本案例 MDP 模型显示，2% 是 42 岁至 75 岁之间患者进行乳腺活检的最佳阈值，但 42 岁以下的阈值较低 (1%)，75 岁以上的阈值较高（范围为 3-5%）。我们的敏感性分析表明，最佳活检阈值随着年龄和活检无效性的变化而变化最为显着。我们的 MDP 模型验证了目前用于活检的 2% 阈值，但表明该最佳阈值随患者年龄和活检无效性而有很大差异。
A 2% threshold, traditionally used as a level above which breast biopsy recommended, has been generalized to all patients from several specific situations analyzed in the literature. We use a sequential decision analytic model considering clinical and mammography features to determine the optimal general threshold for image guided breast biopsy and the sensitivity of this threshold to variation of these features. We built a decision analytical model called a Markov Decision Process (MDP) model, which determines the optimal threshold of breast cancer risk to perform breast biopsy in order to maximize a patient’s total quality-adjusted life years (QALYs). The optimal biopsy threshold is determined based on a patient’s probability of breast cancer estimated by a logistic regression model (LRM) which uses demographic risk factors (age, family history, and hormone use) and mammographic findings (described using the established lexicon–BI-RADS). We estimate the MDP model's parameters using SEER data (prevalence of invasive vs. in situ disease, stage at diagnosis, and survival), US life tables (all cause mortality), and the medical literature (biopsy disutility and treatment efficacy) to determine the optimal “base case” risk threshold for breast biopsy and perform sensitivity analysis. The base case MDP model reveals that 2% is the optimal threshold for breast biopsy for patients between 42 and 75 however the thresholds below age 42 is lower (1%) and above age 75 is higher (range of 3–5%). Our sensitivity analysis reveals that the optimal biopsy threshold varies most notably with changes in age and disutility of biopsy. Our MDP model validates the 2% threshold currently used for biopsy but shows this optimal threshold varies substantially with patient age and biopsy disutility.
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DOI：
10.1016/j.jacr.2004.09.012
发表时间：
2005-04-01
期刊：
Journal of the American College of Radiology : JACR
影响因子：
--
作者：
Chan, Evelyn C Y
通讯作者：
Chan, Evelyn C Y
影响因子：
4.000
作者：
Facundo Garcia-Bournissen;Denice S. Feig;Gideon Koren
通讯作者：
Gideon Koren
DOI：
10.2214/ajr.07.3345
发表时间：
2009-04
期刊：
AJR. American journal of roentgenology
影响因子：
--
作者：
Chhatwal J;Alagoz O;Lindstrom MJ;Kahn CE Jr;Shaffer KA;Burnside ES
通讯作者：
Burnside ES
影响因子：
39.2
作者：
Mandelblatt JS;Cronin KA;Bailey S;Berry DA;de Koning HJ;Draisma G;Huang H;Lee SJ;Munsell M;Plevritis SK;Ravdin P;Schechter CB;Sigal B;Stoto MA;Stout NK;van Ravesteyn NT;Venier J;Zelen M;Feuer EJ;Breast Cancer Working Group of the Cancer Intervention and Surveillance Modeling Network
通讯作者：
Breast Cancer Working Group of the Cancer Intervention and Surveillance Modeling Network
影响因子：
3.5
作者：
Lidgren, Mathias;Wilking, Nils;Rehnberg, Clas
通讯作者：
Rehnberg, Clas