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

描述(申请人提供)：乳腺磁共振成像(MRI)用于乳腺癌女性患者的术前评估已有近20年的历史，但仍是临床争议的主题。虽然众所周知，术前乳腺MRI可以发现更多的癌症，但这对术前检查、手术治疗和结果的影响尚不清楚。一个主要的问题是，检测到更多的癌症是否会导致更积极的检查和手术(乳房切除而不是保乳手术)，而没有任何伴随的好处。以前的研究还没有将基于人群的乳腺MRI的使用与标准成像方式与乳腺癌手术和重要结果(如再次切除、后续肿瘤和死亡率)相关的情况进行比较。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，并了解乳腺癌女性患者的潜在好处和危害。这项拟议的研究将：1)检验术前乳房MRI对额外癌症检测、术前检查的影响，以及与乳房切除和保乳手术的关系；2)比较乳房MRI和乳房X光摄影与再次切除、后续肿瘤事件和死亡率的关系；3)评估术前乳房MRI在全国范围内和子组妇女中的使用情况，例如那些乳腺癌风险增加的妇女；4)通过马尔科夫使用和结果的马尔可夫模型估计术前乳房MRI的使用对整个人群的影响。我们将使用新建立的国家乳腺癌监测联盟(BCSC)登记数据与联邦医疗保险和团体健康索赔数据的联系，以独特和新颖的方式解决这些目标。这些数据将通过增加具有风险因素、共同发病率、临床评估和病理信息的卫生保健利用数据来利用现有资源。BCSC的数据包括大量主要来自社区环境的妇女，使我们能够检查妇女的亚群，例如患有导管原位癌、乳房致密或乳腺癌家族史的妇女，并比以前的研究具有更大的概括性。我们的总体目标是提供关键证据，说明与标准成像模式相比，术前乳腺MRI的有效性，从而为当前的实践方案、妇女的决策和卫生保健政策提供信息。在这个新技术和医疗改革的时代，确定先进的治疗方式是否以及何时使患者受益，对患者和资源分配工作都是至关重要的。

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.