Publication Abstract

Authors: Sharma G, Nishi SP, Lin YL, Kuo YF, Goodwin JS, Riall TS

Title: Pattern of Imaging Following Lung Cancer Resection: 1992-2005.

Journal: Ann Am Thorac Soc :-

Date: 2016 May 31

Abstract: RATIONALE: Imaging intensity following lung cancer resection performed with curative intent is unknown. OBJECTIVE: To describe the pattern and trends in the use of computerized tomography (CT) and positron emission tomography (PET) scans in patients following resection of early-stage lung cancer. METHODS: Retrospective analysis of the linked Surveillance, Epidemiology and End Results (SEER) - Medicare database. Subjects were 8,621 Medicare beneficiaries aged ≥66 years who underwent lung cancer resection with curative intent between 1992 and 2005. A surveillance CT or PET exam was defined as CT or PET imaging performed in an outpatient setting on patients who did not undergo a chest radiograph in the preceding 30 days. MEASUREMENTS AND MAIN RESULTS: Overall, imaging usage was higher within the first 2 years versus years 3-5 following 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 3-fold 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 following surgical resection. The proportion of surveillance CT imaging performed at free-standing imaging centers increased from 18.0% in 1998-1999 to 30.6% in 2004-2005. 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.