Arif Kamal1, Tian Zhang2, Steve Power3, P Kelly Marcom2. 1. From the Division of Medical Oncology and Department of Medicine, Duke University; Duke Cancer Institute, Duke University Medical Center; and Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina. From the Division of Medical Oncology and Department of Medicine, Duke University; Duke Cancer Institute, Duke University Medical Center; and Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina. From the Division of Medical Oncology and Department of Medicine, Duke University; Duke Cancer Institute, Duke University Medical Center; and Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina. 2. From the Division of Medical Oncology and Department of Medicine, Duke University; Duke Cancer Institute, Duke University Medical Center; and Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina. From the Division of Medical Oncology and Department of Medicine, Duke University; Duke Cancer Institute, Duke University Medical Center; and Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina. 3. From the Division of Medical Oncology and Department of Medicine, Duke University; Duke Cancer Institute, Duke University Medical Center; and Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina.
Abstract
BACKGROUND: The American Board of Internal Medicine Foundation's Choosing Wisely initiative aims to reduce unnecessary advanced imaging for early-stage breast cancer (ESBC). Additionally, NCCN Clinical Practice Guidelines in Oncology for Breast Cancer permit such images when oncologists perceive clinical clues of advanced disease. The utility of advanced imaging in ESBC is not known. PATIENTS AND METHODS: We analyzed all patients with ESBC from January 2010 to June 2012 at a large tertiary cancer center. Early-stage was defined as stage IIb or less. We included advanced imaging within 60 days after diagnosis. Three independent reviewers manually abstracted a sample of charts to determine reason for ordering. RESULTS: A total of 1,143 ESBC cases were identified; 21.8% of which had at least one advanced imaging procedure performed. Imaging modalities varied widely (38% CT, 21% PET, 34% bone scans, and 6% MRI). Patients who underwent advanced imaging were more likely to have triple-negative disease, be younger (age <50 years), and have higher stage disease (stage IIb vs ≤ stage IIa; all P<.001). A total of 100 cases (40%) were abstracted; 5 were excluded due to bilateral disease. Of the 95 cases remaining, 62% of the imaging studies were performed for staging, 17% for significant concurrent disease, and 22% for findings atypical of ESBC. Of the studies performed for staging, 15% produced clinically meaningful findings. Overall, 45% of studies were ordered for suspicious findings, complex history, or produced a meaningful result. CONCLUSIONS: Of patients with ESBC, 21.8% had at least one advanced imaging procedure within 60 days of diagnosis; almost half were clinically useful. Chart abstraction helped clarify intent. Conversations between clinicians and patients are needed to balance patient preferences and clinician judgment.
BACKGROUND: The American Board of Internal Medicine Foundation's Choosing Wisely initiative aims to reduce unnecessary advanced imaging for early-stage breast cancer (ESBC). Additionally, NCCN Clinical Practice Guidelines in Oncology for Breast Cancer permit such images when oncologists perceive clinical clues of advanced disease. The utility of advanced imaging in ESBC is not known. PATIENTS AND METHODS: We analyzed all patients with ESBC from January 2010 to June 2012 at a large tertiary cancer center. Early-stage was defined as stage IIb or less. We included advanced imaging within 60 days after diagnosis. Three independent reviewers manually abstracted a sample of charts to determine reason for ordering. RESULTS: A total of 1,143 ESBC cases were identified; 21.8% of which had at least one advanced imaging procedure performed. Imaging modalities varied widely (38% CT, 21% PET, 34% bone scans, and 6% MRI). Patients who underwent advanced imaging were more likely to have triple-negative disease, be younger (age <50 years), and have higher stage disease (stage IIb vs ≤ stage IIa; all P<.001). A total of 100 cases (40%) were abstracted; 5 were excluded due to bilateral disease. Of the 95 cases remaining, 62% of the imaging studies were performed for staging, 17% for significant concurrent disease, and 22% for findings atypical of ESBC. Of the studies performed for staging, 15% produced clinically meaningful findings. Overall, 45% of studies were ordered for suspicious findings, complex history, or produced a meaningful result. CONCLUSIONS: Of patients with ESBC, 21.8% had at least one advanced imaging procedure within 60 days of diagnosis; almost half were clinically useful. Chart abstraction helped clarify intent. Conversations between clinicians and patients are needed to balance patient preferences and clinician judgment.
Authors: Hely Shah; Julian Surujballi; Arif Ali Awan; Brian Hutton; Angel Arnaout; Risa Shorr; Lisa Vandermeer; Mashari Jemaan Alzahrani; Mark Clemons Journal: Breast Cancer Res Treat Date: 2020-11-06 Impact factor: 4.872
Authors: Jung Hee Hong; Jin Mo Goo; Hyeong-Gon Moon; Jung Min Chang; Jong Hyuk Lee; Chang Min Park Journal: PLoS One Date: 2021-02-11 Impact factor: 3.240