低级别导管原位癌的主动监测：对患者、临床医生和卫生系统观点的混合方法系统回顾

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2026-06-01 Epub Date: 2026-03-02 DOI:10.1016/j.amjsurg.2026.116898

Daniella Hui Xin Poh , Cristal Li Yi Tan , Yaoyi Ng , Kevin Xiang Zhou , Qin Xiang Ng , Serene Si Ning Goh

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引用次数: 0

摘要

背景：低级别导管原位癌（DCIS）越来越多地通过乳腺筛查被发现，这引起了人们对过度治疗的担忧。主动监测（AS）已成为即时手术的替代方案。我们综合了与AS采用相关的患者、临床医生和卫生系统的观点。方法我们在PRISMA之后进行了一项混合方法的系统评价（MMSR），使用收敛综合综合方法（PROSPERO CRD420250656621）整合定量、定性和混合方法的研究。PubMed， Embase和Cochrane图书馆从2000年到2025年进行了检索。使用标准化工具评估偏倚风险（RoB）。结果共纳入14项研究。患者的偏好差异很大，受焦虑、术语、感知风险和信任的影响。临床医生强调了对进展风险、病理变异性、医学法律暴露和有限的长期证据的关注。监测途径、风险分层工具和实施支持方面的差距制约了机构的准备程度。总体而言，RoB处于低至中等水平。结论采用AS治疗低级别DCIS不仅取决于临床证据，还取决于心理、沟通和组织因素，这些因素会影响患者、临床医生和卫生系统的决策。

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Active surveillance for low-grade ductal carcinoma in situ: A mixed-methods systematic review of patient, clinician, and health-system perspectives

Background

Low-grade ductal carcinoma in situ (DCIS) is increasingly detected through breast screening, raising concerns about overtreatment. Active surveillance (AS) has emerged as an alternative to immediate surgery. We synthesized patient, clinician, and health-system perspectives relevant to AS adoption.

Methods

We conducted a mixed-methods systematic review (MMSR) following PRISMA, integrating quantitative, qualitative, and mixed-methods studies using a convergent integrated synthesis approach (PROSPERO CRD420250656621). PubMed, Embase, and the Cochrane Library were searched from 2000 to 2025. Risk of bias (RoB) was assessed using standardized tools.

Results

Fourteen studies were included. Patient preferences varied widely and were influenced by anxiety, terminology, perceived risk, and trust. Clinicians highlighted concerns about progression risk, pathology variability, medicolegal exposure, and limited long-term evidence. Institutional readiness was constrained by gaps in surveillance pathways, risk-stratification tools, and implementation support. Overall RoB was low to moderate.

Conclusion

Adoption of AS for low-grade DCIS depends not only on clinical evidence but also on psychological, communication, and organizational factors that shape decision-making across patients, clinicians, and health systems.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.