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

术前 MRI 在乳腺癌手术中的有效性和结果

基本信息

批准号：
8514538
负责人：
Tracy Onega
金额：
$ 54.45万
依托单位：
DARTMOUTH COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-01 至 2016-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8514538
关键词：
Address Area Awareness Benign Bilateral Biopsy Body mass index Breast Breast Cancer Detection Breast Cancer Surveillance Consortium Breast Cancer Treatment Breast-Conserving Surgery Cancer Detection Cancer Patient Caucasians Caucasoid Race Clinical Clinical Practice Guideline Clinical assessments Comorbidity Conflict (Psychology)Contralateral Data Decision Making Detection Diagnostic Diffuse Disease Education Effectiveness Evaluation Event Excision Family Family history of Health Health Care Reform Health Policy Health Service Area Health Status Healthcare Ipsilateral Knowledge Link Magnetic Resonance Imaging Malignant - descriptor Malignant Neoplasms Mammary Neoplasms Mammary Ultrasonography Mammography Mastectomy Medicare Medicare claim Modality Modeling Noninfiltrating Intraductal Carcinoma Operative Surgical Procedures Outcome Outcome Assessment Pathology Patients Pattern Policies Population Procedures Protocols documentation Recommendation Recording of previous events Recurrence Research Resource Allocation Resources Risk Risk Factors Subgroup Surgical Management Time Treatment outcome Ultrasonography Uncertainty Vital Status Woman Work breast density breast lumpectomy breast surgery cancer care cancer risk cancer surgery clinical practice community setting compare effectiveness data registry experience health care service utilization imaging modality improved malignant breast neoplasm markov model mortality neoplasm registry new technology novel outcome forecast patient population population based population health radiologist research study screening tumor young woman

项目摘要

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.

描述（由申请人提供）：乳房磁共振成像（MRI）用于乳腺癌女性的术前评估已有近二十年的历史，但仍然是临床争议的主题。虽然已知术前乳房 MRI 可以检测出其他癌症，但这对术前检查、手术治疗和结果的影响尚不清楚。一个主要问题是，检测到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），而没有任何伴随的好处。先前的研究尚未将乳腺 MRI 的基于人群的使用与标准成像方式与乳腺癌手术和重要结果（例如再切除、随后的肿瘤和死亡率）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，并了解对乳腺癌女性的潜在益处和危害。这项拟议的研究将：1）检查术前乳腺 MRI 对额外癌症检测、术前检查的影响以及与乳房切除术与保乳手术的关系； 2) 比较乳腺 MRI 与乳房 X 光检查 1 超声在再切除、随后的肿瘤事件和死亡率方面的关系； 3) 评估全国范围内以及女性亚组（例如乳腺癌风险增加的女性）中术前乳腺 MRI 的使用情况； 4) 通过利用和结果的马尔可夫模型估计术前乳腺 MRI 使用对人群的影响。我们将利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之间的联系，以独特而新颖的方式实现这些目标。这些数据将通过增加风险因素、共病、临床评估和病理信息的医疗保健利用数据来利用现有资源。 BCSC 数据主要由来自社区环境的大量女性组成，使我们能够检查女性亚组，例如患有导管原位癌、致密乳房或乳腺癌家族史的女性，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腺 MRI 与标准成像方式相比有效性的关键证据，为当前的实践方案、妇女决策和医疗保健政策提供信息。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于患者和资源分配工作都至关重要。