title: Radiographic staging practices of newly diagnosed colorectal cancer vary according to medical specialty.
abstract: BACKGROUND
  Since 2008, multiple guidelines have endorsed incorporation of chest CT in the radiographic staging assessment of newly diagnosed colorectal cancer (CRC). Radiographic staging practices performed after CRC is detected have not been studied.
  
  
  OBJECTIVE
  To evaluate radiographic staging practices for newly diagnosed CRC between gastroenterologists versus non-gastroenterologists.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Single, tertiary-care referral center.
  
  
  METHODS
  Patients newly diagnosed with a T1 or higher stage CRC at time of colonoscopy between 2008 and 2013.
  
  
  METHODS
  Radiographic staging.
  
  
  METHODS
  Radiographic preoperative staging examinations ordered by gastroenterologists in comparison to those ordered by non-gastroenterology specialists.
  
  
  RESULTS
  This study included 277 patients with CRC newly diagnosed by colonoscopy. There were 141 total ordering physicians (68 gastroenterologists and 73 non-gastroenterologists). The majority of preoperative radiographic staging was performed by gastroenterologists (59.2% of patients, n = 164). Colorectal surgeons managed staging in 28.7% of patients (n = 47). Gastroenterologists were more likely to omit a staging chest CT than were non-gastroenterologists (64.6% vs 46.9%; P < .001). Physician practice setting, rectal location of tumor, and advanced endoscopic appearance of tumors were predictors of chest CT inclusion.
  
  
  CONCLUSIONS
  Single center, moderate sample size of both providers and patients.
  
  
  CONCLUSIONS
  Gastroenterologists more frequently ordered the initial radiographic staging studies in newly diagnosed CRC patients. However, gastroenterologists were less likely to include chest CT in the initial staging of CRC despite current guideline recommendations to do so. If confirmed with further studies, educational efforts to improve compliance and standardization may be needed.
authors.affiliation: Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Ma
authors.affiliation: Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Nayak
authors.affiliation: Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Hong
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Kateri
authors.initials: K
authors.lastname: Evans
authors.affiliation: Department of General Surgery, Section of Colon and Rectal Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Francescatti
authors.affiliation: Department of General Surgery, Section of Colon and Rectal Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Marc I
authors.initials: MI
authors.lastname: Brand
authors.affiliation: Department of General Surgery, Section of Colon and Rectal Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Orkin
authors.affiliation: Department of Medicine, Division of Medical Oncology, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Marisa
authors.initials: M
authors.lastname: Hill
authors.affiliation: Department of Radiology, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: James
authors.initials: J
authors.lastname: Cameron
authors.affiliation: Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Sohrab
authors.initials: S
authors.lastname: Mobarhan
authors.affiliation: Department of General Surgery, Section of Colon and Rectal Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Favuzza
authors.affiliation: Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Melson
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000368:Aged; D015331:Cohort Studies; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000473:pathology*; D003107:Colorectal Surgery / Q000592:standards*; D005260:Female; D005762:Gastroenterology / Q000592:standards*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000473:pathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed