目的：一个国际工作组最近发表了一套关于特发性炎症性肌病（IIM）恶性肿瘤筛查的共识指南。这些指南根据“高”提出了不同的调查策略，“中度”或“标准”恶性肿瘤风险组。这项研究比较了澳大利亚三级转诊中心目前的恶性肿瘤筛查实践与这些指南中概述的建议。
方法：我们对新诊断的IIM患者进行了回顾性分析。记录有关恶性肿瘤筛查的相关人口统计学和临床数据。使用描述性统计将现有做法与指南进行比较；使用澳大利亚医疗保险福利计划计算费用。
结果：在确定的47名患者中（66％为女性，中位年龄：63岁[IQR：55.5-70]，中位病程：4年[IQR：3-6])，只有1人筛查出恶性肿瘤.20名患者（43％）处于高风险，20人(43%)处于中等风险；其余7人(15%)有IBM，拟议的指南不建议进行筛查。只有3名（6%）患者接受了与国际肌炎评估和临床研究建议完全一致的筛查。大多数（N=39，83％）进行了筛查；其余5名（11％）过度筛查的患者患有IBM。指南不遵守的主要原因是在诊断后的3年内缺乏对高风险个体的重复年度筛查（0％依从性）。筛查的平均费用大大低于遵循指南的预期（每位患者$481.52[SD423.53]vs$1341[SD935.67]），在高危女性患者中观察到的差异最大（$2314.29/患者）。
结论：实施拟议的指南将显著影响临床实践，并导致潜在的额外经济负担。
OBJECTIVE: An inaugural set of
consensus guidelines for malignancy screening in idiopathic inflammatory myopathy (IIM) were recently published by an international working group. These
guidelines propose different investigation strategies based on \"high\", \"intermediate\" or \"standard\" malignancy risk groups. This study compares current malignancy screening practices at an Australian tertiary referral center with the recommendations outlined in these guidelines.
METHODS: We conducted a retrospective analysis of newly diagnosed IIM patients. Relevant demographic and clinical data regarding malignancy screening were recorded. Existing practice was compared with the
guidelines using descriptive statistics; costs were calculated using the Australian Medicare Benefit Schedule.
RESULTS: Of the 47 patients identified (66% female, median age: 63 years [IQR: 55.5-70], median disease duration: 4 years [IQR: 3-6]), only one had a screening-detected malignancy. Twenty patients (43%) were at high risk, while 20 (43%) were at intermediate risk; the remaining seven (15%) had IBM, for which the proposed guidelines do not recommend screening. Only three (6%) patients underwent screening fully compatible with International Myositis Assessment and Clinical Studies recommendations. The majority (N = 39, 83%) were under-screened; the remaining five (11%) overscreened patients had IBM. The main reason for
guideline non-compliance was the lack of repeated annual screening in the 3 years post-diagnosis for high-risk individuals (0% compliance). The mean cost of screening was substantially lower than those projected by following the
guidelines ($481.52 [SD 423.53] vs $1341 [SD 935.67] per patient), with the highest disparity observed in high-risk female patients ($2314.29/patient).
CONCLUSIONS: Implementation of the proposed guidelines will significantly impact clinical practice and result in a potentially substantial additional economic burden.
