Variations in Preoperative Use of Bone Scan Among Medicare Beneficiaries Undergoing Radical Cystectomy

Abstract

Objectives To examine factors associated with the bone scan use in patients undergoing radical cystectomy and to assess trends in use over time. Methods Using Surveillance, Epidemiology, and End Results-Medicare data, we identified 5,573 patients who underwent radical cystectomy from 2004–2011. The primary outcome was completion of a bone scan within 6 months prior to surgery. Demographic, regional, and clinicopathologic predictors of bone scan use were examined using a mixed logit model with health service area as a random effect. Results Among radical cystectomy patients, 1754 (31%) completed a preoperative bone scan. Urologists ordered most of these studies (69%). The adjusted probability of a patient undergoing a bone scan decreased from 0.40 in 2004 to 0.29 in 2011 (p = 0.01). Compared with patients in the northeast region, those in the south, central, and west regions were less likely to have a bone scan (p < 0.001). Compared with those with stage ≤T1, patients with higher stage disease were more likely to have a bone scan (p < 0.001). Amongst the highest volume surgeons, there was significant variation in the proportion of patients who completed preoperative bone scans (p <0.001). Conclusions Despite a recent decline, bone scans are used frequently in the preoperative staging of bladder cancer. Although some clinical factors are associated with bone scan use, significant regional and provider variation suggest areas to improve standardization of practice.

Routine Preoperative Bone Scintigraphy Has Limited Impact on the Management of Patients with Invasive Bladder Cancer

“…Although not recommended by current guidelines [7,8], many BC centers perform routine baseline bone scintigraphy in the staging of patients with invasive BC who are candidates for RC, PLND, and urinary diversion [14,[16][17][18][19]. The persistence of this practice is probably attributable to the sparsity and low quality of the data on the accuracy of staging bone scintigraphy to detect bone metastases [7,[9][10][11][12][13].…”

Role of nuclear medicine SPECTCT methods in the diagnosis of Urinary Tract Urothelial Cell Cancer

“…Коректното предоперативно стадиране на далечни костни метастази при болни показани за радикална цистектомия е важно за определяне на оптималния терапевтичен план. Наличието на дисеминиран метастатичен процес в скелета е контраиндикация за провеждане на радикално оперативно лечение, като метод на избор при тези случаи, е палиативната терапия (6).…”

“…Целотелесната костна сцинтиграфия е високо чувствително и специфично нуклеарномедицинско изследване за адекватното M стадиране на заболяването, който се прилага рутинно за ранната диагностика и определяне степента на разпространение на вторични лезии в скелета при високорискови болни с рак на пикочния мехур. В САЩ е проведено кохортно проучване на популационно ниво, предназначено да оцени ролята на целотелесната костна сцинтиграфия за предоперативното стадиране на болни с карцином на пикочния мехур, при които е показана радикална цистектомия, обхващащо периода 2004-2011г (6). Анализирани са данните на 5573 болни, при които е проведено радикално хирургично лечение.…”

Bone scan with technetium 99m-methyl diphosphonate, the missing link in the initial staging of muscle-invasive bladder carcinoma

“…Therefore, early detection of bone metastases is essential for choosing appropriate treatment and prognostic stratification. The bone scan is the most common imaging technique to detect bone metastases [4,5].…”

“…Thus, bone scans may be helpful to detect bone metastasis at the time of diagnosis, especially in patients with high-risk conditions as those with advanced-stage cancer or suspicious histologic findings [8]. However, its value in the preoperative staging of BCa is unclear, and there is no consensus on whether a bone scan should be used before surgery [5,9]. The current guideline on bladder staging recommends the use of bone scans in the presence of clinical suspicion, like high alkaline phosphatase (ALP) levels or signs of bone metastasis (e.g.…”