Abstract: PD32-09
Sources of Funding: Robert M. Turner II, MD was supported in part by the National Institutes of Health Institutional TL1 award (5TL1TR000145-10)._x000D_ _x000D_ Bruce L. Jacobs, MD is supported in part by the National Institutes of Health Institutional KL2 award (KL2TR000146-08), the GEMSTAR award (R03AG048091), the Jahnigen Career Development Award, and the Tippins Foundation Scholar Award._x000D_

Introduction

A bone scan may be considered prior to radical cystectomy to exclude bone metastases in high-risk patients. However, false positive bone scans can occur due to tracer uptake in benign bone lesions with reactive osteoblastic change, resulting in the need for additional procedures such as x-ray, computed tomography (CT), magnetic resonance imaging (MRI), and bone biopsy to further evaluate bone scan findings. The current burden of these downstream procedures is unknown. We aim to quantify the use of downstream procedures following staging bone scans in patients with muscle-invasive bladder cancer.

Methods

Using Surveillance, Epidemiology, and End Results (SEER)- Medicare data, we identified 4404 patients diagnosed with muscle-invasive bladder cancer from 2004-2011. We further identified those who underwent a bone scan prior to treatment within 6 months of diagnosis. Using outpatient and carrier claims files, we determined the proportion of patients who underwent a subsequent x-ray, CT, MRI, and/or bone biopsy within 3 months of the bone scan and prior to treatment.

Results

Among patients diagnosed with muscle-invasive bladder cancer during the study period, 1373 (31%) were identified as having completed a staging bone scan. Overall, 231 patients (17%) received downstream bone-specific x-rays, 340 patients (25%) received bone-specific CTs, and 103 patients (8%) received bone-specific MRIs. The use of bone biopsy was rare (n = 17; 1%).

Conclusions

Use of bone scan in the staging of muscle-invasive bladder cancer often results in the need for additional downstream imaging. The cost burden of this downstream imaging highlights a potential disadvantage of the routine use of this staging modality.

Funding

Robert M. Turner II, MD was supported in part by the National Institutes of Health Institutional TL1 award (5TL1TR000145-10)._x000D_ _x000D_ Bruce L. Jacobs, MD is supported in part by the National Institutes of Health Institutional KL2 award (KL2TR000146-08), the GEMSTAR award (R03AG048091), the Jahnigen Career Development Award, and the Tippins Foundation Scholar Award._x000D_