Breast MRI in the Diagnostic and Preoperative Workup Among Medicare Beneficiaries With Breast Cancer.
Breast MRI in the Diagnostic and Preoperative Workup Among Medicare Beneficiaries With Breast Cancer.
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DOI：
10.1097/mlr.0000000000000542
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发表时间：
2016-07
期刊：
影响因子：
3
通讯作者：
Hubbard RA
中科院分区：
文献类型：
--
作者：
Onega T;Weiss JE;Buist DS;Tosteson AN;Henderson LM;Kerlikowske K;Goodrich ME;O'Donoghue C;Wernli KJ;DeMartini WB;Virnig BA;Bennette CS;Hubbard RA
我们根据老年女性的乳房MRI检查结果，比较了乳房成像和活检用于乳腺癌诊断和术前检查的频率和顺序。使用2004-2010年的SEER-Medicare数据，我们确定了有和没有进行乳腺MRI的女性作为乳腺癌诊断和术前检查的一部分，并测量了每名女性乳房成像和活检事件的数量和顺序。10,766名妇女(20%)在诊断/术前期间接受了MRI检查，32,178名妇女(60%)接受了乳房X光检查和US检查，10,669名(20%)妇女仅进行了乳房X光检查。磁共振成像的使用率在研究期间有所增加，从2005年到2009年增加了两倍(9%到29%)。与接受乳房X光检查和US或仅接受乳房X光检查的女性相比，接受MRI检查的女性的乳房成像和活检率更高(分别为5.8vs4.1v2.8)。有4,254个独特的乳房事件序列；接受MRI检查的女性的主要模式是发生在护理路径末端的MRI。在诊断后接受核磁共振检查的妇女中，26%的人进行了后续的活检，而在没有接受MRI的亚组中，51%的人接受了后续的活检。接受乳房核磁共振检查的老年女性要接受额外的乳房成像和活组织检查。老年妇女的诊断/术前检查有很大的差异，这表明有机会提高标准化，以优化对所有妇女的护理。
We compared the frequency and sequence of breast imaging and biopsy use for the diagnostic and preoperative workup of breast cancer according to breast MRI use among older women. Using SEER-Medicare data from 2004–2010, we identified women with and without breast MRI as part of their diagnostic and preoperative breast cancer workup and measured the number and sequence of breast imaging and biopsy events per woman. 10,766 (20%) women had an MRI in the diagnostic/preoperative period, 32,178 (60%) had mammogram and US, and 10,669 (20%) had mammography alone. MRI use increased across study years, tripling from 2005 to 2009 (9% to 29%). Women with MRI had higher rates of breast imaging and biopsy compared to those with mammogram and US or those with mammography alone (5.8 v 4.1 v 2.8; respectively). There were 4,254 unique sequences of breast events; the dominant patterns for women with MRI were an MRI occurring at the end of the care pathway. Among women receiving an MRI post-diagnosis, 26% had a subsequent biopsy compared to 51% receiving a subsequent biopsy in the sub-group without MRI. Older women who receive breast MRI undergo additional breast imaging and biopsy events. There is much variability in the diagnostic/preoperative work-up in older women, demonstrating the opportunity to increase standardization to optimize care for all women.