Inappropriate lung cancer imaging widespread in USA

By Laura Cowen, medwireNews Reporter

A large proportion of patients with lung cancer do not receive guideline-recommended imaging, US study data show.

Positron emission tomography (PET) is generally underused, whereas bone scintigraphy (BS) continues to be overused, report Leah Backhus (University of Washington, Seattle) and colleagues in the Journal of Clinical Oncology.

The researchers assessed the rates of adherence to imaging guideline recommendations for lung cancer staging in 3808 patients diagnosed with stage IIB, IIIA or IIIB lung cancer at a Department of Veterans Affairs medical centre between 2004 and 2007.

“Adherence to treatment and diagnostic guidelines offers the opportunity to provide standardization, reduce waste, and improve care and outcomes”, they write.

Appropriate use of brain imaging and PET was determined according to National Comprehensive Cancer Network guidelines and American College of Radiology Appropriateness Criteria. Both agencies recommend these two imaging modalities for patients with stage IIB, IIIA or IIIB lung cancer.

In addition, both agencies recommend against BS in these patients if PET is used, so the researchers also examined overuse of this combination.

During the 180 days before and after diagnosis, 74.5% of patients received recommended brain imaging, and 59.5% received recommended PET imaging. Overuse of BS in combination with PET occurred in 24.7% of patients.

In multivariable analyses, use of guideline-recommended brain imaging was associated with more advanced clinical stage (stage IIIA odds ratio [OR]=1.67, stage IIIB OR=1.48 vs stage IIB) and later year of diagnosis (2006 OR=1.57, 2007 OR=1.54 vs 2004), whereas increasing age was associated with lower rates of brain imaging (≥75 years OR=0.61, 70–74 years OR=0.69 vs <60 years).

Similarly, later year of diagnosis was associated with increased guideline-recommended PET use (2006 OR=1.91, 2007 OR=2.70) but more advanced clinical stage was associated with lower use (stage IIIA OR=0.73, stage IIIB OR=0.51). Black patients and those treated at centres with a medical school affiliation were also less likely to receive PET (ORs= 0.74 and 0.46, respectively).

For BS, increased overuse in combination with PET was associated with earlier year of diagnosis (2005 OR=1.36), whereas decreased overuse was associated with age older than 75 years (OR=0.75).

Backhus et al note that there was substantial regional variation in their observations, with regions having the highest adherence to appropriate brain and PET imaging also having the highest rates of BS overuse.

However, they caution that their findings “must be interpreted within the context of evolving imaging techniques”, because “more contemporary data might yield different results.”

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