Distribution of metastases in NSCLC: Economic impact of imaging

Abstract

e19036 Background: Purpose: to investigate the usefulness and cost-effectiveness of routine pelvic CT scans in patients with NSCLC. Given that many patients have metastases to several organs, one important question is - “what is the frequency of metastases in the chest, the abdomen, the pelvis, elsewhere?” Methods: We retrospectively reviewed the CT data of 184 patients with Stage 4 NSCLC. The results are shown in Table 1 . Results: We found that there were 690 metastases to the chest, 205 to the abdomen, 80 to the bones, 18 to the pelvis, 13 to the brain and 23 others, not specified. These represent a relative incidence of 67%, 20%, 8%, 2%, 1% and 2%, respectively. These results are a strong indicator of the main areas that require imaging in NSCLC. If we consider the actual incidence of metastases, we find the following absolute statistics: 16 patients had pelvic involvement. This compares with 42 patients with adrenal metastases, 81 with liver metastases, 80 with bone metastases, 112 with hilar adenopathy, and 159 with mediastinal adenopathy. (See Table ) Conclusions: The cost of a CT of the pelvis varies, but is estimated at approximately $2000[Fred, Herbert L., MD, MACP. Drawbacks and Limitations of Computed Tomography: Views from a Medical Educator. Texas Heart Institute Journal 31 (2004): 345.]. The incidence of NSCLC is approximately 172,000 in 2008[Ries, LAG, et al (eds). SEER Cancer Statistics Review, 1975–2005. Surveillance Epidemiology and End Results. 2007. National Cancer Institute. 03JAN2009. http://seer.cancer.gov/csr/1975_2005/ .]. Hence, the potential annual savings accrued by not performing CT of the pelvis is approximately $344 million. These costs can be justified in a Research setting, but it is more difficult to do so in the clinical arena. [Table: see text] No significant financial relationships to disclose.