Non-small-cell lung cancer: Practice patterns of extrathoracic imaging

Rationale and Objectives. The purpose of this study was to identify practice patterns of extrathoracic imaging in patients newly diagnosed with non-small-cell lung cancer. Materials and Methods. The authors retrospectively reviewed the charts of 125 patients (71 men, 54 women; mean age, 67 years) from five hospitals (25 patients each) with newly diagnosed non-small-cell lung cancer. Charts were reviewed for cancer cell type, evidence of metastatic disease, and performance and results of extrathoracic imaging, including computed tomography (CT) and magnetic resonance (MR) imaging of the brain, bone scanning, and abdominal CT. Results. Of 125 patients, 77 (62%) underwent extrathoracic imaging. These patients included 64 (64%) of 100 patients with clinical symptoms or laboratory signs of metastatic disease and 13 (52%) of 25 patients with no such indications. Extrathoracic imaging did not differ according to cancer cell type: It was performed for 30 (60%) of 50 patients with squamous cell carcinoma, 26 (60%) of 43 patients with adenocarcinoma, and 16 (73%) of 22 patients with non-small-cell lung cancer that was not further characterized. Brain CT or MR imaging, bone scanning, or abdominal CT were performed in only 48%, 39%, and 30% of patients, respectively. Brain CT or MR images or bone scans revealed metastatic disease in seven of 20 and nine of 22 patients with clinical symptoms or laboratory signs of disease, respectively. These examinations revealed disease in four of 40 and two of 27 patients without such symptoms or signs, respectively (P < .05). No significant differences emerged among the practice patterns at the five participating hospitals. Conclusion. No consensus was found on performance of extrathoracic imaging in patients with newly diagnosed non-small-cell lung cancer.