Effectiveness of Pre-Operative MRI in Breast Cancer Surgery and Outcomes

描述（由申请人提供）：乳房磁共振成像（MRI）已被用于乳腺癌妇女的术前评估近二十年，但仍是临床争议的主题。虽然术前乳房MRI已知可以检测到额外的癌症，但它对术前检查、手术治疗和结果的影响尚不清楚。一个主要的问题是，发现额外的癌症是否会导致更积极的检查和手术（乳房切除术而不是保乳手术），而没有任何附带的好处。先前的研究没有比较基于人群的乳房MRI与标准成像方式的使用与乳腺癌手术和重要结果（如再次切除、后续肿瘤和死亡率）的关系。扩大乳腺MRI的使用需要对这些结果进行大规模评估，以便为临床实践指南提供信息，并了解乳腺癌妇女的潜在益处和危害。本研究将：1)检查术前乳房MRI对其他癌症检测、术前检查的影响以及与乳房切除术和保乳手术的关系；2)比较乳腺MRI与乳腺x光1超声与再切除、后续肿瘤事件和死亡率的关系；3)评估术前乳房MRI在全国范围内和妇女亚组中的使用情况，如乳腺癌风险增加的妇女；4)通过使用和结果的马尔可夫模型估计术前乳房MRI使用对人群的影响。我们将使用新建立的国家乳腺癌监测联盟（BCSC）注册数据与医疗保险和团体健康索赔数据的联系，以一种独特而新颖的方式解决这些目标。这些数据将利用现有资源，通过增加医疗保健利用数据，包括风险因素、共发病、临床评估和病理信息。BCSC数据包括主要来自社区环境的大量妇女，使我们能够检查妇女的亚组，例如导管原位癌，致密乳房或乳腺癌家族史，并且比以前的研究具有更大的普遍性。我们的总体目标是提供关于术前乳房MRI与标准成像方式的有效性的关键证据，以告知当前的实践协议、妇女决策和卫生保健政策。在这个新技术和医疗改革的时代，确定先进模式是否以及何时对患者有益，对患者和资源分配工作都至关重要。

DESCRIPTION (provided by applicant): Breast magnetic resonance imaging (MRI) has been used for preoperative evaluation in women with breast cancer for almost two decades, but is still the subject of clinical controversy. While preoperative breast MRI is known to detect additional cancer, the impact of this on preoperative work-up, surgical treatment and outcomes is not clear. A major question is whether detecting additional cancer leads to more aggressive work-up and surgery (mastectomy instead of breast conserving surgery) without any concomitant benefits. Prior studies have not compared population-based use of breast MRI with standard imaging modalities in relation to breast cancer surgery and important outcomes, such as re-excision, subsequent tumors, and mortality. Expanding use of breast MRI necessitates a large-scale assessment of these outcomes to inform clinical practice guidelines and to understand potential benefits and harms for women with breast cancer. This proposed research will: 1) examine the influence of preoperative breast MRI on additional cancer detection, preoperative work-ups and the relation with mastectomy vs. breast conserving surgery; 2) compare breast MRI with mammography 1 ultrasound in relation to re-excision, subsequent tumor events, and mortality; 3) assess utilization of preoperative breast MRI nationally and in subgroups of women, such as those with increased breast cancer risk; 4) estimate population-wide impacts of preoperative breast MRI use through Markov models of utilization and outcomes. We will use newly established linkages of the national Breast Cancer Surveillance Consortium (BCSC) registry data with Medicare and Group Health claims data to address these aims in a unique and novel way. These data will leverage existing resources by augmenting health care utilization data with risk factor, co morbidity, clinical assessment, and pathology information. The BCSC data consists of a large population of women primarily from community settings, enabling us to examine subgroups of women, such as those with ductal carcinoma in situ, dense breasts or family history of breast cancer, and to have greater generalizability than previous studies. Our overall objective is to provide critical evidence about the effectiveness of preoperative breast MRI compared to standard imaging modalities to inform current practice protocols, women's decision-making and health care policies. In this era of new technologies and health care reform, identifying if and when advanced modalities benefit patients is of the utmost importance to both patients and resource allocation efforts.