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首页> 外文学位 >Comparative effectiveness and cost of preoperative breast MRI in elderly breast cancer patients.
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Comparative effectiveness and cost of preoperative breast MRI in elderly breast cancer patients.

机译：老年乳腺癌患者术前乳房MRI的比较效果和费用。

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摘要

Preoperative breast magnetic resonance imaging (MRI) has been used increasingly in the preoperative evaluation of women with newly diagnosed breast cancer. Despite its rapid adoption, limited evidence exists to support the routine use of breast MRI, creating controversy in breast cancer management. Existing evidence suggests that breast MRI may change treatment patterns, leading to surgical treatment delay and more extensive surgeries but may not improve patient outcomes. This study is one of the first to examine the association between preoperative breast MRI and surgical planning (i.e., time to complete surgery and type of initial surgery), short-term outcomes (i.e., re-excision and second breast cancer event rates), and cost in the elderly women using a large, population-based dataset.;In this observational, retrospective analysis, we identified women diagnosed with early-stage (I-IIB), operable breast cancer from 2004-2007 in the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset. Medicare claims were used to define the initial treatment phase, to identify breast cancer treatments, and to categorize Medicare payments. Second breast cancer events (i.e., recurrence or a second primary breast cancer) were identified through an algorithm validated in breast cancer patients. To control for measured confounders, we used propensity score methods.;Twelve percent of our sample had a preoperative breast MRI. Compared to women who did not undergo breast MRI, we found that receipt of breast MRI was associated with a median 15-day delay in complete surgery and an increased likelihood of a mastectomy as the initial surgery. Breast MRI was not significantly associated with re-excision rates, but was associated with an increased hazard of a second breast cancer event. Women who received a breast MRI had higher total all-cause and breast cancer-attributable costs during the initial treatment phase than those women who did not undergo a breast MRI.;Since findings from this dissertation indicate that breast MRI was associated with a slight surgical delay and an increased likelihood of a mastectomy in the absence of evidence for improved short-term outcomes, healthcare providers and elderly breast cancer patients should consider these factors when making informed decisions about whether the use of breast MRI is appropriate.
机译：术前乳房磁共振成像（MRI）已被越来越多地用于新诊断乳腺癌的术前评估中。尽管它被迅速采用，但是仍然有有限的证据支持常规使用乳房MRI，从而在乳腺癌治疗中引起争议。现有证据表明，乳房MRI可能会改变治疗方式，导致手术治疗延迟和更广泛的手术，但可能不会改善患者预后。这项研究是第一个研究术前乳房MRI与手术计划（即完成手术的时间和初次手术的类型），短期结局（即再次切除和第二次乳腺癌事件发生率）之间相关性的研究之一，使用大型的基于人群的数据集分析老年妇女的成本和费用。在这项观察性，回顾性分析中，我们从监测，流行病学，2004-2007年中确定了被诊断为早期（I-IIB）可手术乳腺癌的妇女，和最终结果（SEER）-医疗保险数据集。 Medicare索赔用于定义初始治疗阶段，识别乳腺癌治疗方法以及对Medicare付款进行分类。通过在乳腺癌患者中验证的算法，识别出第二次乳腺癌事件（即复发或第二次原发性乳腺癌）。为了控制测量的混杂因素，我们使用了倾向评分法。;我们样本中有12％进行了术前乳房MRI检查。与未接受乳腺MRI检查的女性相比，我们发现接受乳腺MRI检查与完整手术的中位数延迟15天以及首次手术时乳房切除术的可能性增加有关。乳房MRI与再切除率没有显着相关，但与第二次乳腺癌事件的危险增加相关。接受乳腺MRI检查的女性在初始治疗阶段的总全因和乳腺癌归因成本要高于未接受乳腺MRI检查的女性。由于本论文的发现表明，乳腺MRI与轻微的外科手术有关在缺乏改善短期预后的证据的情况下，乳房切除术的延迟和乳房切除术的可能性增加，因此，在就使用乳房MRI是否合适做出明智的决定时，医疗服务提供者和老年乳腺癌患者应考虑这些因素。

著录项

  • 作者

    Fortune-Greeley, Alice K.;

  • 作者单位

    The University of North Carolina at Chapel Hill.;

  • 授予单位 The University of North Carolina at Chapel Hill.;
  • 学科 Health Sciences Oncology.;Health Sciences General.;Health Sciences Radiology.
  • 学位 Ph.D.
  • 年度 2013
  • 页码 279 p.
  • 总页数 279
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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