Purpose. The aim of this study was to assess compliance with guidelines recommendations in the follow-up of patients with breast cancer. In this setting of patients we analyzed the appropriateness of the imaging exams recommended by different specialists in the management of follow-up. Materials and methods. From January 2019 to December 2019 we analyzed the clinical data and the results of the imaging exams of 146 asymptomatic patients followed for follow-up in different regional radiotherapy centers. A logistic regression analysis was performed taking into account the advanced pathological stage, the absence of surgical staging of the lymph nodes, the dubious results from previous basic imaging tests, correlating them to the excessive use of advanced imaging. The association was expressed in terms of odds ratio (OR) together with their 95% confidence intervals (CI). Results. For 96% of patients, a frequent prescription of at least one basic imaging exam (complete abdomen ETG and chest X-ray 2p) was observed in contrast to the guidelines. A finding of a large number of bone scans suggested their use as routine surveillance A positive correlation with advanced imaging (OR <1) was seen in patients with borderline basic imaging. Conclusions. Follow-up with intensive imaging is poorly effective both for the early diagnosis of relapses and for any remote localizations.
Scopo. Scopo di questo studio è stato valutare il rispetto alle raccomandazioni delle linee guida nel follow-up di pazienti affette da carcinoma mammario. In questo setting di pazienti abbiamo analizzato l’appropriatezza degli esami di imaging consigliati da differenti figure specialistiche nella gestione del follow-up. Materiali e metodi. Da gennaio 2019 a dicembre 2019 abbiamo analizzato i dati clinici e gli esiti degli esami di imaging di 146 pazienti asintomatiche seguite per follow-up in diversi centri di radioterapia regionali. È stata eseguita un’analisi di regressione logistica tenendo conto dello stadio patologico avanzato, dell’assenza di stadiazione chirurgica dei linfonodi, degli esiti dubbi a precedenti esami di imaging di base correlandoli all’uso eccessivo di imaging avanzato. L’associazione è stata espressa in termini di odds ratio (OR) insieme ai loro intervalli di confidenza al 95% (IC). Risultati. Per il 96% delle pazienti è stata osservata una frequente prescrizione di almeno un esame di imaging di base (ETG dell’addome completo e radiografia del torace) in contrasto con le linee guida. Un riscontro di un elevato numero di scintigrafie scheletriche ha suggerito il loro utilizzo come sorveglianza di routine. Nelle pazienti con imaging di base borderline è stata vista una correlazione positiva con l’imaging avanzato (OR<1). Conclusioni. Il follow-up con imaging intensivo è scarsamente efficace sia per la diagnosi precoce delle recidive, sia per le eventuali localizzazioni a distanza.
Imaging in breast cancer follow-up: preliminary investigation on clinical practice adherence to the guidelines
Sardaro A.;Altini C.;Frugis M. T.;Ferrari C.;Mammucci P.;Rubini D.;Maggialetti N.
;Rubini G.
2021-01-01
Abstract
Purpose. The aim of this study was to assess compliance with guidelines recommendations in the follow-up of patients with breast cancer. In this setting of patients we analyzed the appropriateness of the imaging exams recommended by different specialists in the management of follow-up. Materials and methods. From January 2019 to December 2019 we analyzed the clinical data and the results of the imaging exams of 146 asymptomatic patients followed for follow-up in different regional radiotherapy centers. A logistic regression analysis was performed taking into account the advanced pathological stage, the absence of surgical staging of the lymph nodes, the dubious results from previous basic imaging tests, correlating them to the excessive use of advanced imaging. The association was expressed in terms of odds ratio (OR) together with their 95% confidence intervals (CI). Results. For 96% of patients, a frequent prescription of at least one basic imaging exam (complete abdomen ETG and chest X-ray 2p) was observed in contrast to the guidelines. A finding of a large number of bone scans suggested their use as routine surveillance A positive correlation with advanced imaging (OR <1) was seen in patients with borderline basic imaging. Conclusions. Follow-up with intensive imaging is poorly effective both for the early diagnosis of relapses and for any remote localizations.File | Dimensione | Formato | |
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Imaging nel follow-up del carcinoma mammario indagine preliminare sulladerenza della pratica clinica alle linee guida.pdf
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