Pattern of Imaging after Lung Cancer Resection. 1992–2005

Abstract

Rationale: Imaging intensity after lung cancer resection performed with curative intent is unknown.Objectives: To describe the pattern and trends in the use of computed tomography (CT) and positron emission tomography (PET) scans in patients after resection of early-stage lung cancer. Measurements and Main Results: Overall, imaging use was higher within the first 2 years versus Years 3-5 after surgical resection. Use of surveillance CT scans increased sharply from 13.7 to 57.3% of those diagnosed in 1996-1997 and 2004-2005, respectively. PET scan use increased threefold, from 6.2% in 2000-2001 to 19.6% in 2004-2005. In multivariable analyses, we observed a 32% increase in the odds of undergoing surveillance CT or PET imaging for every year of diagnosis between 1998 and 2005. There was no substantial decline in the odds of having a surveillance CT or PET scan during each successive follow-up period, suggesting no change in the intensity of surveillance over the first 5 years after surgical resection. The proportion of surveillance CT imaging performed at freestanding imaging centers increased from 18.0% in 1998-1999 to 30.6% in 2004-2005. Methods Conclusions:The use of CT and PET imaging for surveillance after curative-intent surgical resection of early-stage lung cancer increased sharply in the United States between 1997-1998 and 2005. In the absence of evidence demonstrating favorable outcomes, this practice was likely driven by prevailing expert opinion embedded in clinical practice guidelines made available during that time. Research is clearly needed to determine the role and optimal approach to surveillance thoracic imaging after surgical resection of lung cancer.

Post-treatment Surveillance for Stage I and II Non-small Cell Lung Cancer: Impact on Clinical Outcome

“…It is remarkable that, in our study, most patients who received a CT scan anywhere in their follow-up, received it in the first year of follow-up (67%). This was comparable to the trend seen by Sharma et al (15); they noticed a decrease from 41.2% to 27.3% in the number of CT scans made during five years of follow-up. The outcomes in this study were comparable with the observational data from Sharma et al (15).…”

“…This was comparable to the trend seen by Sharma et al (15); they noticed a decrease from 41.2% to 27.3% in the number of CT scans made during five years of follow-up. The outcomes in this study were comparable with the observational data from Sharma et al (15). While using the same way of counting radiological examinations, they found a 15-month survival of 84% for the whole cohort; the 12-month survival in our whole cohort was 84%.…”

Surveillance With PET/CT and Liquid Biopsies of Stage I-III Lung Cancer Patients After Completion of Definitive Therapy: A Randomized Controlled Trial (SUPER)

“…11 Despite the scarcity of evidence, the use of PET/ceCT for follow-up has been increasing, but better evidence for the role of PET/ceCT is needed. 12 Blood carries various potential cancer biomarkers, such as circulating tumor cells, microRNA, and ctDNA. In particular, ctDNA detected in plasma or serum has been shown to be a valuable prognostic and predictive marker for early detection of relapse.…”

Cost Analysis of PET/CT Versus CT as Surveillance for Stage III Non–Small-Cell Lung Cancer After Definitive Radiation Therapy

“…These results are concordant with recent findings indicating a significant increase in PET/CT use over the past 2 decades. 6, 29, 30 Interestingly, the provider characteristic associated with use of increased PET/CT technology was ≥ 10 years of experience for radiation oncologists, which might signify a time-related dissociation from standard practice guidelines. Our findings contribute to the literature by elucidating the differences (or lack thereof) in charges for PET/CT versus CT for surveillance and by identifying the patient and provider qualities correlated with a preference for PET/CT in a group of patients with concordant clinical data.…”

“…Nevertheless, PET/CT remains a preferred modality of surveillance among some providers, and PET/CT usage has increased substantially from 1997/1998 to 2005. 6, 7 …”