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Chest xray for RCC follow up surveillance, silly?
Just wondering if you guys are still seeing this, chest x-rays obtained “RCC r/o mets” which just seems silly to me. It can easily and probably will miss early mets, when low dose Chest CT is not much more radiation and will detect >90% of mets.
AUA guidelines still recommend this for follow up surveillance post nephrectomy (partial or total). These are updated guidelines (2021). ACR appropriateness addresses it and they provide multiple studies were all or nearly all patients who developed mets (retrospective review) had negative surveillance chest x-rays. These patients either became symptomatic, or got a chest CT for some other indication, which detected it.
The practice just seems silly. Every other cancer in the body is staged and surveilled with CT. An oncologist would probably think surveillance with CXR is nuts. And it is, if you look at the performance its just terrible. If you’re going to try and surveil for metastases, why not do it right? -
12 Replies
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Yeah, its completely non evidence based. Typical urology
I think nccn recommends chest ct
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Ridiculous.
I’d put a disclaimer. Something to the effect of “CXR is not sensitive for subcentimeter pulmonary nodules and CT is indicated if clinical suspicion persists for metastases”.
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Yep,
I also add a disclaimer to ALL chest radiographs looking for mets.-
Agree with the above. I usually just see a couple dinosaurs routinely order these. I have no reservation in telling them that the study is useless, because it is.
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Or you see a tiny opacity that could be a nodule and recommend ct..
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I see this all the time. It is in the urology guidelines. The urology society probably thinks they are doing good by saving the patient/system money.
I usually look at lung bases on the CT abd/pelvis from same day and say no radiographic evidence of metastatic disease.
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No evidence of large solid met
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I usually just say “You get what you pay for. Consider assesment with LDCT as well as interpretation by a non corporate employed radiologist”
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In my experience, urologists think of highly of rads as ortho surgeons
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It is at least 10 years since we did CXR’s as follow ups for RCC. Always CT TAP’s. Urologists pathway was advised by Radiology in the UK
The downside is the repeat CT to check on the 3mm lung lesions we always find.
Our urologists like us. We bail them out with neph insertions when they get stuck trying to stent a ureteric stone or when the patient is too ill to have a GA. It helps meeting every week at cancer MDT’s(cancer boards in the US) so you get to know them and their foibles.-
If you dont want to chase down ditzels it is fine for RCC met screening. The question is when would you start treatment for metastatic diseasewhen the lesion is big enough for biopsy and there is a benefit to treatmentgiven that the majority of RCC mets are indolent, there is not necessarily a benefit to early detection
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Sure CT is better, but you do end up wasting money and pt anxiety following irrelevant stuff, and Is there an actual benefit to catching them a bit earlier? I dunno.
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