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Is Advanced Imaging in Early-Stage Breast Cancer Ever Warranted? Reconciling Clinical Judgment With Common Quality Measures.

Publication ,  Journal Article
Kamal, A; Zhang, T; Power, S; Marcom, PK
Published in: J Natl Compr Canc Netw
August 2016

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.

Duke Scholars

Published In

J Natl Compr Canc Netw

DOI

EISSN

1540-1413

Publication Date

August 2016

Volume

14

Issue

8

Start / End Page

993 / 998

Location

United States

Related Subject Headings

  • Quality of Health Care
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Multimodal Imaging
  • Middle Aged
  • Humans
  • Female
  • Diagnostic Imaging
  • Clinical Decision-Making
  • Breast Neoplasms
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Kamal, A., Zhang, T., Power, S., & Marcom, P. K. (2016). Is Advanced Imaging in Early-Stage Breast Cancer Ever Warranted? Reconciling Clinical Judgment With Common Quality Measures. J Natl Compr Canc Netw, 14(8), 993–998. https://doi.org/10.6004/jnccn.2016.0106
Kamal, Arif, Tian Zhang, Steve Power, and P Kelly Marcom. “Is Advanced Imaging in Early-Stage Breast Cancer Ever Warranted? Reconciling Clinical Judgment With Common Quality Measures.J Natl Compr Canc Netw 14, no. 8 (August 2016): 993–98. https://doi.org/10.6004/jnccn.2016.0106.
Kamal A, Zhang T, Power S, Marcom PK. Is Advanced Imaging in Early-Stage Breast Cancer Ever Warranted? Reconciling Clinical Judgment With Common Quality Measures. J Natl Compr Canc Netw. 2016 Aug;14(8):993–8.
Kamal, Arif, et al. “Is Advanced Imaging in Early-Stage Breast Cancer Ever Warranted? Reconciling Clinical Judgment With Common Quality Measures.J Natl Compr Canc Netw, vol. 14, no. 8, Aug. 2016, pp. 993–98. Pubmed, doi:10.6004/jnccn.2016.0106.
Kamal A, Zhang T, Power S, Marcom PK. Is Advanced Imaging in Early-Stage Breast Cancer Ever Warranted? Reconciling Clinical Judgment With Common Quality Measures. J Natl Compr Canc Netw. 2016 Aug;14(8):993–998.

Published In

J Natl Compr Canc Netw

DOI

EISSN

1540-1413

Publication Date

August 2016

Volume

14

Issue

8

Start / End Page

993 / 998

Location

United States

Related Subject Headings

  • Quality of Health Care
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Multimodal Imaging
  • Middle Aged
  • Humans
  • Female
  • Diagnostic Imaging
  • Clinical Decision-Making
  • Breast Neoplasms