To quantify the use of downstream studies following staging bone scans in patients with muscle-invasive bladder cancer. Bone scans may be obtained in high-risk bladder cancer patients prior to radical cystectomy to exclude bone metastases. However, false positive bone scans can occur, resulting in the need for additional studies.
Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified 4404 patients diagnosed with muscle-invasive bladder cancer from 2004-2011. We further identified those who underwent a bone scan prior to treatment within 6 months of diagnosis and prior to any treatment with cystectomy, radiotherapy, or chemotherapy. We determined the proportion of patients who underwent a subsequent study (bone x-ray, bone CT, bone MRI, and/or bone biopsy) within 3 months of the bone scan and prior to treatment.
Among patients diagnosed with muscle-invasive bladder cancer, 1373 (31%) had a staging bone scan of whom 26% received a downstream study (n=213). Overall, 61 patients (7%) received downstream bone-specific x-rays, more than 141 patients (>17%) received bone-specific CTs, and 28 patients (3%) received bone-specific MRIs. The use of bone biopsy was rare (n<11; < 1%). The total cost of all downstream studies was $103,468. Furthermore, there was a one-month delay in treatment for those who received a downstream study compared to those who did not (p < 0.001).
Use of bone scan in the staging of muscle-invasive bladder cancer often results in the need for additional downstream studies. The delay in treatment and cost burden of downstream studies highlights a potential disadvantage of the routine use of this staging modality.
Urology. 2019 Apr 18 [Epub ahead of print]
Avinash Maganty, Robert M Turner, Jonathan G Yabes, Benjamin J Davies, Dwight E Heron, Bruce L Jacobs
Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: ., Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: ., Division of Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: ., Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: ., Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA. Electronic address: ., Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA; Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: .