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：
8895856
负责人：
Tracy Onega
金额：
$ 52.85万
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 2017-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8895856
关键词：
Address Area Awareness Benign Bilateral Biopsy Body mass index Breast Breast Cancer Detection Breast Cancer Patient Breast Cancer Surveillance Consortium Breast Cancer Treatment Breast biopsy Breast-Conserving Surgery Cancer Detection Caucasians 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）：将乳腺磁共振成像（MRI）用于乳腺癌女性术前评估已有近二十年了，但仍然是临床争议的主题。虽然已知术前乳房MRI检测到其他癌症，但术前检查对术前检查，手术治疗和结局的影响尚不清楚。一个主要问题是检测其他癌症是否导致更具侵略性的检查和手术（乳房切除术而不是乳房保存手术），而没有任何伴随的益处。先前的研究尚未将基于人群的乳房MRI使用与乳腺癌手术有关的标准成像方式以及重要的结果，例如重新筛选，随后的肿瘤和死亡率。扩大乳房MRI的使用需要对这些结果进行大规模评估，以告知临床实践指南，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）检查术前乳房MRI对其他癌症检测，术前检查以及与乳房切除术与乳房保存手术的关系； 2）将乳房MRI与乳房X线摄影1进行比较，1与重新筛选，随后的肿瘤事件和死亡率有关的超声； 3）评估全国术前乳房MRI和在妇女的亚组中的利用，例如乳腺癌风险增加的妇女； 4）通过马尔可夫的利用和结果模型估算术前乳房MRI使用的影响。我们将使用Medicare和Group Health Sapel Sape Sagation数据的国家乳腺癌监视财团（BCSC）注册表数据的新建立联系，以独特而新颖的方式解决这些目标。这些数据将通过使用风险因素，发病率，临床评估和病理信息来增强医疗保健利用数据来利用现有资源。 BCSC数据主要由大量妇女组成，主要来自社区环境，使我们能够检查女性的亚组，例如那些原位导管癌，浓密的乳房或乳腺癌家族史的女性，并具有比以前的研究更大的概括性。我们的总体目标是提供有关术前乳房MRI的有效性与标准成像方式相比的关键证据，以告知当前实践方案，妇女的决策和医疗保健政策。在这个新技术和医疗保健改革的时代，确定对患者和资源分配工作至关重要。

项目成果

期刊论文数量（2）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Breast MRI in the Diagnostic and Preoperative Workup Among Medicare Beneficiaries With Breast Cancer.

DOI：
10.1097/mlr.0000000000000542
发表时间：
2016-07
期刊：
Medical care
影响因子：
3
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
通讯作者：
Hubbard RA