{"title":"乳房疼痛成像:促进乳腺癌筛查和减少不必要的乳腺成像的有效范例。","authors":"","doi":"10.1016/j.clinimag.2024.110253","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Identify the proportion of patients presenting for diagnostic breast imaging with clinically insignificant breast pain who are eligible for screening mammography and analyze the impact of routing these patients to screening on resource utilization, healthcare spending and cancer detection.</p></div><div><h3>Methods</h3><p>We retrospectively reviewed 100 consecutive women ≥40 years old without a history of breast cancer who underwent diagnostic mammogram and breast ultrasound for clinically insignificant breast pain from 1/2022 to 4/2022. Patients were screen-eligible if their last bilateral mammogram was over 12 months prior to presentation. Patients with only screening views during diagnostic mammography were assumed to have a negative/benign screening mammogram. Costs were calculated using the Centers for Medicare & Medicaid Services Physician Fee Schedule.</p></div><div><h3>Results</h3><p>68 of 100 patients with breast pain were screen-eligible at time of diagnostic imaging. With a screen first approach, 47/68 would have had negative/benign screening mammograms, allowing for the availability of 47 diagnostic breast imaging appointments. The current workflow led to 100 diagnostic mammograms and ultrasounds, 29 follow-up ultrasounds, and 10 image-guided biopsies, with a total cost of $42,872.41. With a screen first approach, there would have been 68 screening mammograms, 53 diagnostic mammograms and ultrasounds, 10 follow-up ultrasounds, and 9 image-guided biopsies, with a total cost of $34,231.60. Two cancers were identified, both associated with suspicious mammographic findings. None would have been missed in a screen-first approach.</p></div><div><h3>Discussion</h3><p>Identifying screen-eligible patients with clinically insignificant breast pain and routing them to screening mammogram improves radiology resource allocation and decreases healthcare spending without missing any cancers.</p></div>","PeriodicalId":50680,"journal":{"name":"Clinical Imaging","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0899707124001839/pdfft?md5=70981d55587708a379d2c7c978f618ea&pid=1-s2.0-S0899707124001839-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Imaging for breast pain: A useful paradigm to promote breast cancer screening and reduce unnecessary breast imaging\",\"authors\":\"\",\"doi\":\"10.1016/j.clinimag.2024.110253\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>Identify the proportion of patients presenting for diagnostic breast imaging with clinically insignificant breast pain who are eligible for screening mammography and analyze the impact of routing these patients to screening on resource utilization, healthcare spending and cancer detection.</p></div><div><h3>Methods</h3><p>We retrospectively reviewed 100 consecutive women ≥40 years old without a history of breast cancer who underwent diagnostic mammogram and breast ultrasound for clinically insignificant breast pain from 1/2022 to 4/2022. Patients were screen-eligible if their last bilateral mammogram was over 12 months prior to presentation. Patients with only screening views during diagnostic mammography were assumed to have a negative/benign screening mammogram. Costs were calculated using the Centers for Medicare & Medicaid Services Physician Fee Schedule.</p></div><div><h3>Results</h3><p>68 of 100 patients with breast pain were screen-eligible at time of diagnostic imaging. With a screen first approach, 47/68 would have had negative/benign screening mammograms, allowing for the availability of 47 diagnostic breast imaging appointments. The current workflow led to 100 diagnostic mammograms and ultrasounds, 29 follow-up ultrasounds, and 10 image-guided biopsies, with a total cost of $42,872.41. With a screen first approach, there would have been 68 screening mammograms, 53 diagnostic mammograms and ultrasounds, 10 follow-up ultrasounds, and 9 image-guided biopsies, with a total cost of $34,231.60. Two cancers were identified, both associated with suspicious mammographic findings. None would have been missed in a screen-first approach.</p></div><div><h3>Discussion</h3><p>Identifying screen-eligible patients with clinically insignificant breast pain and routing them to screening mammogram improves radiology resource allocation and decreases healthcare spending without missing any cancers.</p></div>\",\"PeriodicalId\":50680,\"journal\":{\"name\":\"Clinical Imaging\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2024-08-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S0899707124001839/pdfft?md5=70981d55587708a379d2c7c978f618ea&pid=1-s2.0-S0899707124001839-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Imaging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0899707124001839\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Imaging","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0899707124001839","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
摘要
目标:确定因临床症状不明显的乳房疼痛而接受乳腺造影诊断的患者中符合乳腺造影筛查条件的比例,并分析这些患者接受筛查对资源利用率、医疗支出和癌症检测的影响:确定临床症状不明显的乳房疼痛患者中符合乳腺 X 线照相筛查条件的比例,并分析这些患者接受筛查对资源利用、医疗支出和癌症检测的影响:我们对 2022 年 1 月 1 日至 2022 年 4 月 4 日期间因临床症状不明显的乳房疼痛而接受乳腺 X 线造影和乳腺超声诊断的 100 名年龄≥40 岁、无乳腺癌病史的连续女性进行了回顾性研究。如果患者最近一次双侧乳房 X 光检查是在就诊前 12 个月以上,则符合筛查条件。在诊断性乳腺 X 光检查中仅获得筛查视野的患者被假定为乳腺 X 光检查结果为阴性/良性。费用根据美国医疗保险与医疗补助服务中心的医生收费表计算:在 100 名乳房疼痛患者中,有 68 名在诊断成像时符合筛查条件。如果采用先筛查的方法,47/68 的患者将获得阴性/良性乳房 X 光筛查结果,从而可预约 47 次乳房 X 光诊断。按照目前的工作流程,需要进行 100 次诊断性乳腺 X 光检查和超声波检查、29 次随访超声波检查和 10 次图像引导活检,总费用为 42,872.41 美元。如果采用筛查优先的方法,则需要进行 68 次筛查乳房 X 光检查、53 次诊断乳房 X 光检查和超声波检查、10 次随访超声波检查和 9 次图像引导活检,总费用为 34,231.60 美元。发现了两例癌症,均与可疑的乳房 X 光检查结果有关。如果采用筛查优先的方法,则不会漏掉任何一个癌症:讨论:识别临床症状不明显的符合筛查条件的乳房疼痛患者,并安排他们进行乳房 X 线造影筛查,可以改善放射科的资源分配,减少医疗支出,同时不会漏掉任何癌症。
Imaging for breast pain: A useful paradigm to promote breast cancer screening and reduce unnecessary breast imaging
Objective
Identify the proportion of patients presenting for diagnostic breast imaging with clinically insignificant breast pain who are eligible for screening mammography and analyze the impact of routing these patients to screening on resource utilization, healthcare spending and cancer detection.
Methods
We retrospectively reviewed 100 consecutive women ≥40 years old without a history of breast cancer who underwent diagnostic mammogram and breast ultrasound for clinically insignificant breast pain from 1/2022 to 4/2022. Patients were screen-eligible if their last bilateral mammogram was over 12 months prior to presentation. Patients with only screening views during diagnostic mammography were assumed to have a negative/benign screening mammogram. Costs were calculated using the Centers for Medicare & Medicaid Services Physician Fee Schedule.
Results
68 of 100 patients with breast pain were screen-eligible at time of diagnostic imaging. With a screen first approach, 47/68 would have had negative/benign screening mammograms, allowing for the availability of 47 diagnostic breast imaging appointments. The current workflow led to 100 diagnostic mammograms and ultrasounds, 29 follow-up ultrasounds, and 10 image-guided biopsies, with a total cost of $42,872.41. With a screen first approach, there would have been 68 screening mammograms, 53 diagnostic mammograms and ultrasounds, 10 follow-up ultrasounds, and 9 image-guided biopsies, with a total cost of $34,231.60. Two cancers were identified, both associated with suspicious mammographic findings. None would have been missed in a screen-first approach.
Discussion
Identifying screen-eligible patients with clinically insignificant breast pain and routing them to screening mammogram improves radiology resource allocation and decreases healthcare spending without missing any cancers.
期刊介绍:
The mission of Clinical Imaging is to publish, in a timely manner, the very best radiology research from the United States and around the world with special attention to the impact of medical imaging on patient care. The journal''s publications cover all imaging modalities, radiology issues related to patients, policy and practice improvements, and clinically-oriented imaging physics and informatics. The journal is a valuable resource for practicing radiologists, radiologists-in-training and other clinicians with an interest in imaging. Papers are carefully peer-reviewed and selected by our experienced subject editors who are leading experts spanning the range of imaging sub-specialties, which include:
-Body Imaging-
Breast Imaging-
Cardiothoracic Imaging-
Imaging Physics and Informatics-
Molecular Imaging and Nuclear Medicine-
Musculoskeletal and Emergency Imaging-
Neuroradiology-
Practice, Policy & Education-
Pediatric Imaging-
Vascular and Interventional Radiology