Risk of Cancer in Incidental Findings Identified on Ultrasound Imaging

描述(由申请人提供)：Rebecca Smith-Bindman是加州大学旧金山分校(UCSF)放射学、流行病学和生物统计学、产科、妇科和生殖医学副教授，也是大学放射结果研究实验室的主任。她的研究重点是评估常用筛查和诊断测试的临床影响。她正在申请以患者为导向研究的中期职业调查员奖，以评估与超声成像发现的偶然发现相关的癌症风险，并通过为这些实习生创建研究计划，增加她致力于教授和指导放射学住院医师和以患者为导向研究的研究员的时间。如果获得资金，Smith-Bindman博士将完成拟议的研究，制定一项计划，鼓励放射学实习生开始从事临床癌症预防研究，包括每年对6-8名实习生进行一对一指导。这一奖项提供了一个理想的机会来推进她自己的研究议程，并通过制定一个指导初级调查人员的计划来推进她的职业生涯。 在过去的10年里，成像技术的进步和成像使用的急剧增加使人们能够检测出越来越小和可疑的解剖病变。癌症的早期诊断对患者健康的积极影响怎么强调都不为过。然而，提高影像利用率和分辨率的一个后果是诊断出越来越多的偶发和不确定的发现。尽管与这些发现相关的病理风险被认为非常低(几乎完全是假阳性诊断)，但对于它们的重要性和临床意义的不确定性，以及缺乏管理指南，往往会产生广泛的进一步测试和监测，以排除隐匿性恶性肿瘤。 拟议研究的目的是确定：1)不同适应症导致颈部、乳房和骨盆超声成像的频率；2)与这些检查相关的偶然/不确定发现的发生率，以及与这些偶然/不确定发现相关的癌症风险；以及3)评估这些病变的监测模式。为了实现这些目标，史密斯-宾德曼博士将对1997-2004年间在华盛顿州西雅图的大型非营利性健康维护组织Group Health登记的患者进行回顾性队列研究。Group Health有500,000多名成员，他们在研究期间接受了20多万次超声成像测试。我们将把Group Health的详细自动化临床数据，包括所有放射学测试的适应症和结果，与区域监测流行病学和最终结果肿瘤登记联系起来，以确定所有参与者的癌症发病率，并与成像结果相关联。我们将利用这些分析的结果来制定循证实践指南，以管理超声成像中发现的偶发发现。

DESCRIPTION (provided by applicant): Rebecca Smith-Bindman is an Associate Professor of Radiology, Epidemiology and Biostatistics, Obstetrics, Gynecology and Reproductive Medicine at the University of California, San Francisco (UCSF) and director of the Universities' Radiology Outcomes Research Lab. Her research focuses on evaluating the clinical impact of commonly used screening and diagnostic tests. She is applying for a Mid Career Investigator Award in Patient Oriented Research to evaluate the risk of cancer associated with incidental findings identified on ultrasound imaging, and to increase the time she devotes to teaching and mentoring radiology residents and fellows in patient oriented research through creation of a research program for these trainees. If funded, Dr. Smith-Bindman will complete the proposed research, develop a program to encourage radiology trainees to embark on careers in clinical cancer prevention research including one-on-one mentoring of 6-8 trainees annually. This award provides an ideal opportunity to advance her own research agenda and advance her career by developing a program to mentor junior investigators. Over the last 10 years, advances in imaging technology and dramatic increases in the use of imaging have allowed the detection of increasingly smaller and questionable anatomic lesions. The positive impact on patient health from the earlier diagnosis of cancer cannot be overstated. However, one consequence of the increased imaging utilization and resolution is the diagnosis of increasing numbers of incidental and indeterminate findings. Although the pathology risks associated with theses findings is considered very low (the are almost entirely false positive diagnoses), uncertainty regarding their importance and clinical significance, and lack of management guidelines, often generated extensive further testing and surveillance to exclude occult malignancy. The aims of the proposed study are to determine: 1) the frequency that different indications lead to ultrasound imaging of the neck, breast and pelvis 2) the prevalence of incidental/indeterminate findings associated with these examinations and the risk of cancer associated with these incidental/indeterminate findings and 3) to assess surveillance patterns of these lesions. To complete these aims, Dr. Smith-Bindman will conduct a retrospective cohort study of patients enrolled between 1997-2004 in Group Health, a large Not-for-Profit health maintenance organization in Seattle Washington. Group Health has over 500,000 members who obtained over 200,000 ultrasound imaging tests over the years of the study. We will link Group Health's detailed automated clinical data, including indication and result of all radiology testing, with regional Surveillance Epidemiology and End Results tumor registry to determine cancer incidence among all enrollees and associated with the imaging findings. We will use the results of these analyses to develop evidence-based practice guidelines for the management of incidental findings identified on ultrasound imaging.