Skip to main content
Erschienen in: Annals of Surgical Oncology 1/2013

01.01.2013 | Breast Oncology

Advanced Imaging Modalities in Early Stage Breast Cancer: Preoperative Use in the United States Medicare Population

verfasst von: Margaret L. Crivello, MD, Karen Ruth, MS, Elin R. Sigurdson, MD, PhD, Brian L. Egleston, PhD, Kathryn Evers, MD, Yu-Ning Wong, MD, Marcia Boraas, MD, Richard J. Bleicher, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 1/2013

Einloggen, um Zugang zu erhalten

Abstract

Background

Guidelines for breast cancer staging exist, but adherence remains unknown. This study evaluates patterns of imaging in early stage breast cancer usually reserved for advanced disease.

Methods

Surveillance Epidemiology, and End Results data linked to Medicare claims from 1992–2005 were reviewed for stage I/II breast cancer patients. Claims were searched for preoperative performance of computed tomography (CT), positron emission tomography (PET), bone scans, and brain magnetic resonance imaging (MRI) (“advanced imaging”).

Results

There were 67,874 stage I/II breast cancer patients; 18.8 % (n = 12,740) had preoperative advanced imaging. The proportion of patients having CT scans, PET scans, and brain MRI increased from 5.7 % to 12.4 % (P < 0.0001), 0.8 % to 3.4 % (P < 0.0001) and 0.2 % to 1.1 % (P = 0.008), respectively, from 1992 to 2005. Bone scans declined from 20.1 % to 10.7 % (P < 0.0001). “Breast cancer” (174.x) was the only diagnosis code associated with 62.1 % of PET scans, 37.7 % of bone scans, 24.2 % of CT, and 5.1 % of brain MRI. One or more symptoms or metastatic site was suggested for 19.6 % of bone scans, 13.0 % of CT, 13.0 % of PET, and 6.2 % of brain MRI. Factors associated (P < 0.05) with use of all modalities were urban setting, breast MRI and ultrasound. Breast MRI was the strongest predictor (P < 0.0001) of bone scan (odds ratio [OR] 1.63, 95 % confidence interval [CI] 1.44–1.86), Brain MRI (OR 1.74, 95 % CI 1.15–2.63), CT (OR 2.42, 95 % CI 2.12–2.76), and PET (OR 5.71, 95 % CI 4.52–7.22).

Conclusions

Aside from bone scans, performance of advanced imaging is increasing in early stage Medicare breast cancer patients, with limited rationale provided by coded diagnoses. In light of existing guidelines and increasing scrutiny about health care costs, greater reinforcement of current indications is warranted.
Literatur
1.
Zurück zum Zitat Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2011;61:133–4.CrossRef Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2011;61:133–4.CrossRef
4.
Zurück zum Zitat Brennan ME, Houssami N. Evaluation of the evidence on staging imaging for detection of asymptomatic distant metastases in newly diagnosed breast cancer. Breast. 2012;21:112–23.PubMedCrossRef Brennan ME, Houssami N. Evaluation of the evidence on staging imaging for detection of asymptomatic distant metastases in newly diagnosed breast cancer. Breast. 2012;21:112–23.PubMedCrossRef
5.
Zurück zum Zitat Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF. Overview of the SEER–Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care. 2002;40:IV-3–18. Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF. Overview of the SEER–Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care. 2002;40:IV-3–18.
6.
Zurück zum Zitat FDG positron emission tomography—breast cancer. Decision memorandum CAG-00094A. Washington, DC: CMS; 2002. FDG positron emission tomography—breast cancer. Decision memorandum CAG-00094A. Washington, DC: CMS; 2002.
7.
Zurück zum Zitat Zylstra S, D’Orsi CJ, Ricci BA, et al. Defense of breast cancer malpractice claims. Breast J. 2001;7:76–90.PubMedCrossRef Zylstra S, D’Orsi CJ, Ricci BA, et al. Defense of breast cancer malpractice claims. Breast J. 2001;7:76–90.PubMedCrossRef
8.
Zurück zum Zitat Dick JF 3rd, Gallagher TH, Brenner RJ, et al. Predictors of radiologists’ perceived risk of malpractice lawsuits in breast imaging. AJR Am J Roentgenol. 2009;192:327–33.PubMedCrossRef Dick JF 3rd, Gallagher TH, Brenner RJ, et al. Predictors of radiologists’ perceived risk of malpractice lawsuits in breast imaging. AJR Am J Roentgenol. 2009;192:327–33.PubMedCrossRef
9.
Zurück zum Zitat Bassett LW, Dhaliwal SG, Eradat J, et al. National trends and practices in breast MRI. AJR Am J Roentgenol. 2008;191:332–9.PubMedCrossRef Bassett LW, Dhaliwal SG, Eradat J, et al. National trends and practices in breast MRI. AJR Am J Roentgenol. 2008;191:332–9.PubMedCrossRef
10.
Zurück zum Zitat Kuhl C, Weigel S, Schrading S, et al. Prospective multicenter cohort study to refine management recommendations for women at elevated familial risk of breast cancer: the EVA trial. J Clin Oncol. 2010;28:1450–7.PubMedCrossRef Kuhl C, Weigel S, Schrading S, et al. Prospective multicenter cohort study to refine management recommendations for women at elevated familial risk of breast cancer: the EVA trial. J Clin Oncol. 2010;28:1450–7.PubMedCrossRef
11.
Zurück zum Zitat Houssami N, Hayes DF. Review of preoperative magnetic resonance imaging (MRI) in breast cancer: should MRI be performed on all women with newly diagnosed, early stage breast cancer? CA Cancer J Clin. 2009;59:290–302.PubMedCrossRef Houssami N, Hayes DF. Review of preoperative magnetic resonance imaging (MRI) in breast cancer: should MRI be performed on all women with newly diagnosed, early stage breast cancer? CA Cancer J Clin. 2009;59:290–302.PubMedCrossRef
12.
Zurück zum Zitat Dinan MA, Curtis LH, Hammill BG, et al. Changes in the use and costs of diagnostic imaging among Medicare beneficiaries with cancer, 1999–2006. JAMA. 2010;303:1625–31.PubMedCrossRef Dinan MA, Curtis LH, Hammill BG, et al. Changes in the use and costs of diagnostic imaging among Medicare beneficiaries with cancer, 1999–2006. JAMA. 2010;303:1625–31.PubMedCrossRef
13.
Zurück zum Zitat Wasif N, Maggard MA, Ko CY, Giuliano AE. Invasive lobular vs. ductal breast cancer: a stage-matched comparison of outcomes. Ann Surg Oncol. 2010;17:1862–9.PubMedCrossRef Wasif N, Maggard MA, Ko CY, Giuliano AE. Invasive lobular vs. ductal breast cancer: a stage-matched comparison of outcomes. Ann Surg Oncol. 2010;17:1862–9.PubMedCrossRef
14.
Zurück zum Zitat Hilsenbeck SG, Ravdin PM, de Moor CA, Chamness GC, Osborne CK, Clark GM. Time-dependence of hazard ratios for prognostic factors in primary breast cancer. Breast Cancer Res Treat. 1998;52:227–37.PubMedCrossRef Hilsenbeck SG, Ravdin PM, de Moor CA, Chamness GC, Osborne CK, Clark GM. Time-dependence of hazard ratios for prognostic factors in primary breast cancer. Breast Cancer Res Treat. 1998;52:227–37.PubMedCrossRef
15.
Zurück zum Zitat Myers RE, Johnston M, Pritchard K, Levine M, Oliver T; Breast Cancer Disease Site Group of the Cancer Care Ontario Practice Guidelines Initiative. Baseline staging tests in primary breast cancer: a practice guideline. CMAJ. 2001;164:1439–44.PubMed Myers RE, Johnston M, Pritchard K, Levine M, Oliver T; Breast Cancer Disease Site Group of the Cancer Care Ontario Practice Guidelines Initiative. Baseline staging tests in primary breast cancer: a practice guideline. CMAJ. 2001;164:1439–44.PubMed
16.
Zurück zum Zitat Barrett T, Bowden DJ, Greenberg DC, Brown CH, Wishart GC, Britton PD. Radiological staging in breast cancer: which asymptomatic patients to image and how. Br J Cancer. 2009;101:1522–8.PubMedCrossRef Barrett T, Bowden DJ, Greenberg DC, Brown CH, Wishart GC, Britton PD. Radiological staging in breast cancer: which asymptomatic patients to image and how. Br J Cancer. 2009;101:1522–8.PubMedCrossRef
17.
Zurück zum Zitat Gerber B, Seitz E, Müller H, et al. Perioperative screening for metastatic disease is not indicated in patients with primary breast cancer and no clinical signs of tumor spread. Breast Cancer Res Treat. 2003;82:29–37.PubMedCrossRef Gerber B, Seitz E, Müller H, et al. Perioperative screening for metastatic disease is not indicated in patients with primary breast cancer and no clinical signs of tumor spread. Breast Cancer Res Treat. 2003;82:29–37.PubMedCrossRef
18.
Zurück zum Zitat Segaert I, Mottaghy F, Ceyssens S, et al. Additional value of PET-CT in staging of clinical stage IIB and III breast cancer. Breast J. 2010;16:617–24.PubMedCrossRef Segaert I, Mottaghy F, Ceyssens S, et al. Additional value of PET-CT in staging of clinical stage IIB and III breast cancer. Breast J. 2010;16:617–24.PubMedCrossRef
19.
Zurück zum Zitat Nattinger AB, Schapira MM, Warren JL, Earle CC. Methodological issues in the use of administrative claims data to study surveillance after cancer treatment. Med Care. 2002;40:IV-69–74. Nattinger AB, Schapira MM, Warren JL, Earle CC. Methodological issues in the use of administrative claims data to study surveillance after cancer treatment. Med Care. 2002;40:IV-69–74.
Metadaten
Titel
Advanced Imaging Modalities in Early Stage Breast Cancer: Preoperative Use in the United States Medicare Population
verfasst von
Margaret L. Crivello, MD
Karen Ruth, MS
Elin R. Sigurdson, MD, PhD
Brian L. Egleston, PhD
Kathryn Evers, MD
Yu-Ning Wong, MD
Marcia Boraas, MD
Richard J. Bleicher, MD
Publikationsdatum
01.01.2013
Verlag
Springer-Verlag
Erschienen in
Annals of Surgical Oncology / Ausgabe 1/2013
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2571-4

Weitere Artikel der Ausgabe 1/2013

Annals of Surgical Oncology 1/2013 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.