Use of Surveillance Imaging Following Treatment of Small Renal Masses

Kowalczyk, Keith; Harbin, Andrew; Choueiri, Toni K.; Hevelone, Nathanael D.; Lipsitz, Stuart R.; Trinh, Quoc Dien; Shih, Ya Chen Tina; Hu, Jim C.

doi:10.1016/j.juro.2013.05.109

Cited by 19 publications

(17 citation statements)

References 28 publications

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“…Lin and colleagues [11] conducted a systematic review to estimate 10-year exposure levels incurred by adherence to different postsurgical surveillance protocols; they found substantial variability, with corresponding exposure levels ranging from 0 to 102 mSv; no corresponding risk projections were made. Kowalczyk and colleagues [43], in an analysis of national cancer registry data, reported a stronger association between RFA and surveillance CT relative to surgical strategies; corresponding exposure or risk projections were not reported.…”

Section: Surgerymentioning

confidence: 97%

Radiation Exposure From CT-Guided Ablation of Renal Masses: Effects on Life Expectancy

Eisenberg

Gervais

Singh

et al. 2015

American Journal of Roentgenology

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OBJECTIVE. The purpose of this article is to project the effects of radiation exposure on life expectancy (LE) in patients who opt for CT-guided radiofrequency ablation (RFA) instead of surgery for renal cell carcinoma (RCC). MATERIALS AND METHODS. We developed a decision-analytic Markov model to compare LE losses attributable to radiation exposure in hypothetical 65-year-old patients who undergo CT-guided RFA versus surgery for small (≤ 4 cm) RCC. We incorporated mortality risks from RCC, radiation-induced cancers (for procedural and follow-up CT scans), and all other causes; institutional data informed the RFA procedural effective dose. Radiation-induced cancer risks were generated using an organ-specific approach. Effects of varying model parameters and of dose-reduction strategies were evaluated in sensitivity analysis. RESULTS. Cumulative RFA exposures (up to 305.2 mSv for one session plus surveillance) exceeded those from surgery (up to 87.2 mSv). In 65-year-old men, excess LE loss from radiation-induced cancers, comparing RFA to surgery, was 11.7 days (14.6 days for RFA vs 2.9 days for surgery). Results varied with sex and age; this difference increased to 14.6 days in 65-year-old women and to 21.5 days in 55-year-old men. Dose-reduction strategies that addressed follow-up rather than procedural exposure had a greater impact. In 65-year-old men, this difference decreased to 3.8 days if post-RFA follow-up scans were restricted to a single phase; even elimination of RFA procedural exposure could not achieve equivalent benefits. CONCLUSION. CT-guided RFA remains a safe alternative to surgery, but with decreasing age, the higher burden of radiation exposure merits explicit consideration. Dose-reduction strategies that target follow-up rather than procedural exposure will have a greater impact.

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Section: Surgerymentioning

confidence: 97%

Radiation Exposure From CT-Guided Ablation of Renal Masses: Effects on Life Expectancy

Eisenberg

Gervais

Singh

et al. 2015

American Journal of Roentgenology

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“…Laparoscopic partial nephrectomy was also a predictor of continued yearly abdominal surveillance imaging. The association between increased use of surveillance abdominal CT scans and both open and minimally-invasive partial nephrectomy has been reported in the past [15,16]. With a concomitant increase in performance of partial nephrectomy, population-based estimates of 15.3% in 2002 and 24.7% in 2008 [17], and accessibility of CT scans during our study period, the increasing performance of abdominal surveillance imaging may not be completely independent.…”

Section: Discussionmentioning

confidence: 56%

“…However, yearly surveillance imaging dropped off rapidly (Figure 2). With multiple studies demonstrating that lungs are the most common site for non-local recurrence following nephrectomy (estimates from 3–16% of patients) [4–7, 14], the majority of pulmonary recurrence occurring without symptoms [16], and the accessibility of obtaining a yearly CXR in the Medicare population that not infrequently require a CXR for non-cancer related complaints, the overall number of patients receiving yearly chest imaging is both surprisingly and inappropriately low. Less than half (42%) of the patients with T1 disease in our study received yearly chest surveillance imaging for the first three years, which is the minimum recommendation by the AUA.…”

Section: Discussionmentioning

confidence: 99%

Limited use of surveillance imaging following nephrectomy for renal cell carcinoma

Kim

Vetter

Kuxhausen

et al. 2016

Urologic Oncology: Seminars and Original Investigations

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OBJECTIVES To evaluate the utilization of follow-up imaging after nephrectomy for renal cell carcinoma (RCC) in nationally representative data. PATIENTS AND METHODS Using Surveillance, Epidemiology, End Results (SEER) data linked to Medicare records, we identified patients with RCC who received nephrectomy from 1991 to 2007. Patients were stratified by tumor stage. Postoperative chest and abdominal imaging (including chest x-ray, CT scan, and MRI; abdominal ultrasound, CT scan, and MRI) was assessed. Observed surveillance imaging frequency was compared to published protocols. Predictors of initial and continued yearly surveillance imaging were identified. RESULTS Agreement between observed imaging frequency and evidence-based surveillance protocols was low, particularly for patients with T2-T4 disease. For patients who were not censored prior to 13 months, initial abdominal and chest surveillance imaging was obtained in 69% and 78% of patients, respectively. By year five, 28% and 39% of patients with high risk disease (T3 or T4), as compared to 21% and 25% of patients with low to moderate risk disease (T1 and T2) , received yearly surveillance abdominal and chest imaging, respectively. High risk disease was predictive of initial chest (OR 1.38) and abdominal (OR 1.6) imaging, as well as continued yearly chest (HR 0.73) and abdominal (HR 0.74) imaging surveillance. For abdominal imaging, more contemporary year of surgery was predictive of initial (1997–2001, OR 1.6; 2002–2007, OR 2.4) and continued yearly surveillance (1997–2001, HR 0.82; 2002–2007; HR 0.67). CONCLUSIONS In the Medicare population, surveillance imaging is performed in a limited number of patients following nephrectomy for RCC. However, increasing tumor stage is predictive of both increased chest and abdominal imaging surveillance.

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“…35,36 In fact, many studies of posttreatment surveillance in patients with other malignancies have been performed using the SEER-Medicare database. 4,5,20,21,37 The population in the SEER-Medicare data set has also been found to be generalizable to the elderly American population. 38 Although the Original Article current study cohort was primarily aged 65 years, this is an important patient population to study because the fastest increase in thyroid cancer incidence has been observed in this age group.…”

Section: Discussionmentioning

confidence: 90%

Trends in imaging after diagnosis of thyroid cancer

Wiebel

Banerjee

Muenz

et al. 2015

Cancer

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Background The largest growth in differentiated thyroid cancer (DTC) diagnosis is in low-risk cancers. Trends in imaging after DTC diagnosis are understudied. Hypothesizing a reduction in imaging utilization due to rising low-risk disease, we evaluated post-diagnosis imaging patterns over time and patient characteristics that are associated with likelihood of imaging. Methods Using the Surveillance Epidemiology and End Results-Medicare database, we identified patients diagnosed with localized, regional or distant DTC between 1991 and 2009. We reviewed Medicare claims for neck ultrasound, I-131 scan, or PET scan within 3 years post-diagnosis. Using regression analyses we evaluated trends of imaging utilization. Multivariable logistic regression was used to estimate the likelihood of imaging based on patient characteristics. Results 23,669 patients were included. Patients diagnosed during 2001-2009, compared to 1991-2000, were more likely to have localized disease (p<0.001) and tumors less than 1cm (p<0.001). Use of neck ultrasound and I-131 scan increased in patients with localized disease (p=<0.001 and p=0.003, respectively), regional disease (p<0.001 and p<0.001), and distant metastasis (p=0.001 and p=0.015). Patients diagnosed after 2000 were more likely to undergo neck ultrasound (OR 2.15, 95% CI 2.02-2.28) and I-131 scan (OR 1.44, 95% CI 1.35-1.54). PET scan use from 2005-2009, compared to 1996-2004, increased 32.4-fold (p=<0.001) in localized patients, 13.1-fold (p<0.001) in regional disease patients, and 33.4-fold (p<0.001) in patients with distant DTC. Conclusion Despite a rise in low-risk disease, the use of post-diagnosis imaging increased in all stages of disease. The largest growth was in use of PET scan after 2004.

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Use of Surveillance Imaging Following Treatment of Small Renal Masses

Cited by 19 publications

References 28 publications

Radiation Exposure From CT-Guided Ablation of Renal Masses: Effects on Life Expectancy

Radiation Exposure From CT-Guided Ablation of Renal Masses: Effects on Life Expectancy

Limited use of surveillance imaging following nephrectomy for renal cell carcinoma

Trends in imaging after diagnosis of thyroid cancer

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