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J Thorac Cardiovasc Surg 2005;129:652-660
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

Surveillance computed tomography after complete resection for non–small cell lung cancer: Results and costs

^a Division of Thoracic Surgery, Department of Cardiothoracic Surgery,
^b Department of Genetic Medicine,
^c Department of Public Health,
^d Department of Surgery, Weill Medical College of Cornell University, New York, NY

Read at the Eighty-fourth Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 25-28, 2004.

Received for publication April 23, 2004; revisions received September 29, 2004; accepted for publication October 12, 2004.

^* Address for reprints: Robert J. Korst, MD, Department of Cardiothoracic Surgery, Weill Medical College of Cornell University, 525 East 68th St, Room M-404, New York, NY 10021 (E-mail: rjk2002{at}med.cornell.edu).

OBJECTIVE: We sought to determine the prevalence of defined abnormalities on surveillance computed tomography after complete resection for non–small cell lung cancer, as well as the nature and cost of further testing prompted by these abnormalities. We also sought to determine whether resectable metachronous lung cancer can be detected with surveillance scans.

METHODS: A retrospective analysis was performed of all patients who presented for follow-up in 2002 after complete resection for non–small cell lung cancer. Data collected included demographics, clinicopathologic features of the initial lung cancer, the number and results of surveillance computed tomographic scans performed in 2002, the attending surgeons' impressions of the surveillance scans, the nature of any abnormalities and further diagnostic testing prompted by these abnormalities, and the nature of any lung cancer detected on surveillance scans, as well as the treatment rendered. The cost of surveillance scanning and associated diagnostics was computed by using Medicare fee schedules.

RESULTS: Two hundred thirteen patients met the criteria for inclusion in the study cohort. One hundred sixty-eight surveillance scans were performed in 140 of these patients. One hundred five scans were interpreted as abnormal by the radiologist with regard to pulmonary nodules, adenopathy, or pleural fluid, but the surgeon was suspicious for recurrent or new primary lung cancer in only 32 of 105 scans. Further workup revealed recurrent or new primary lung cancer in 16 of 32 patients, with 6 undergoing resection for localized disease. The cost of the surveillance scans and associated care in the study cohort were 16.6% higher than the cost of care in a hypothetically identical cohort not subjected to surveillance scanning.

CONCLUSIONS: Surveillance computed tomography is frequently abnormal after complete resection for non–small cell lung cancer; however, the majority of these abnormalities are not clinically suspicious. Resectable metachronous lung cancer is detected by using surveillance scanning; however, the use of this modality can be associated with increased cost.

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