实施选择明智的指导方针:省略淋巴结手术
Jenna N Whitrock1, Catherine G Pratt1, Szu-Aun Long1
1Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
Surgery
|October 9, 2024
概括
尽管有指导方针,但大多数符合条件的早期乳腺癌患者仍然接受哨兵淋巴结活检. 从2017年到2020年,遗漏率略有增加,但仍然存在显著的使用不足.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 医疗保健服务研究 医疗服务研究
背景情况:
- "明智选择"运动于2016年发布了指导方针,建议针对特定早期乳腺癌患者的哨兵淋巴结活检.
- 这些指导方针针对70岁或以上的临床结节阴性女性,患有激素受体阳性,HER2阴性早期乳腺癌.
研究的目的:
- 评估2016年"明智选择"指导方针在现实世界中实施的情况,该指导方针涉及哨戒淋巴结活检遗漏.
- 确定与采用这些基于证据的建议相关的趋势和因素.
主要方法:
- 分析国家癌症数据库 (2017-2020年).
- 包括符合淋巴结手术标准的患者. 遗漏.
- 忽略患者与接受淋巴结手术的患者之间的比较.
主要成果:
- 超过79%的符合条件的患者接受了淋巴结手术,尽管指南建议不这样做.
- 淋巴结手术遗漏在老年患者,并发病率较高的患者和学术/研究机构中更为常见.
- 遗漏率从2017年的17.7%增加到2020年的23.1%.
结论:
- 对哨戒淋巴结活检遗漏的"明智选择"指导方针的采用仍然不够理想.
- 需要进一步的研究来了解指导方针实施的障碍.
- 改善遵守基于证据的建议的战略是有必要的.
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