title: Limited use of surveillance imaging following nephrectomy for renal cell carcinoma.
abstract: OBJECTIVE
  To evaluate the utilization of follow-up imaging after nephrectomy for renal cell carcinoma (RCC) in nationally representative data.
  
  
  METHODS
  Using Surveillance, Epidemiology, End Results data linked to Medicare records, we identified patients with RCC who received nephrectomy from 1991 to 2007. Patients were stratified by tumor stage. Postoperative chest and abdominal imaging (including chest x-ray, computed tomography scan, and magnetic resonance imaging; abdominal ultrasound, computed tomography scan, and magnetic resonance imaging) was assessed. Observed surveillance imaging frequency was compared to published protocols. Predictors of initial and continued yearly surveillance imaging were identified.
  
  
  RESULTS
  Agreement between observed imaging frequency and evidence-based surveillance protocols was low, particularly for patients with T2-T4 disease. For patients who were not censored before 13 months, initial abdominal and chest surveillance imaging was obtained in 69% and 78% of patients, respectively. By year 5, 28% and 39% of patients with high-risk disease (T3 or T4), as compared to 21% and 25% of patients with low to moderate risk disease (T1 and T2), received yearly surveillance abdominal and chest imaging, respectively. High-risk disease was predictive of initial chest (odds ratio [OR] = 1.38) and abdominal (OR = 1.6) imaging, as well as continued yearly chest (hazard ratio [HR] = 0.73) and abdominal (HR = 0.74) imaging surveillance. For abdominal imaging, more contemporary year of surgery was predictive of initial (1997-2001, OR = 1.6; 2002-2007, OR = 2.4) and continued yearly surveillance (1997-2001, HR = 0.82; 2002-2007; HR = 0.67).
  
  
  CONCLUSIONS
  In the Medicare population, surveillance imaging is performed in a limited number of patients following nephrectomy for RCC. However, increasing tumor stage is predictive of both increased chest and abdominal imaging surveillance.
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, St Louis, MO.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Kim
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, St Louis, MO.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Vetter
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, St Louis, MO.
authors.forename: Adrienne N
authors.initials: AN
authors.lastname: Kuxhausen
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, St Louis, MO.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Song
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, St Louis, MO.
authors.forename: Gurdarshan S
authors.initials: GS
authors.lastname: Sandhu
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, St Louis, MO. Electronic address: stropes@wudosis.wustl.edu.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Strope
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000601:surgery*; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011184:Postoperative Period; D018426:SEER Program / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014463:Ultrasonography / Q000706:statistics & numerical data; D014481:United States
keywords: Diagnostic imaging; Recurrence; Renal cell carcinoma; Surveillance