Trends in imaging utilization for small cell lung cancer: a decision tree analysis of the NCCN guidelines


      • Imaging utilization for SCLC conformed with NCCN guideline changes from 2003 to 2019.
      • Extensive stage SCLC had an increase in emergency imaging based on diagnosis date.
      • Outpatient imaging of SCLC using MRI and FDG-PET increased based on diagnosis date.



      To investigate the differences in small cell lung cancer (SCLC) diagnostic imaging utilization relative to National Comprehensive Cancer Network (NCCN) guidelines.


      We retrospectively reviewed SCLC records at our institution between January 1, 2003 and August 1, 2019 (n = 529). Patients were grouped by extensive-stage versus limited-stage and diagnosis date. Clinical, CT, MRI, and nuclear imaging data was collected. Imaging utilization was compared using Student's t-test or Kruskal-Wallis-test/Wilcoxon-Rank-Sums test. Survival was compared using Log-rank-test and Kaplan-Meier-curves.


      SCLC patients had a median survival of 290 days. Extensive-stage patients with SCLC demonstrated an increase in emergency imaging utilization when diagnosed in 2011–2019 compared to 2003–2010 (CT abdomen/pelvis p < 0.001, CTA chest for pulmonary embolism p < 0.01, CT head p < 0.003). Limited-stage patients with SCLC demonstrated an increase in inpatient imaging utilization (CT abdomen/pelvis p < 0.04) and decreased total/outpatient imaging utilization (CT chest-abdomen-pelvis p < 0.05, CT head p < 0.003) when diagnosed in 2011–2019 compared to 2003–2010. All patients with SCLC had decreased average number of bone-scan studies when diagnosed in 2011–2019 compared to 2003–2010 (Extensive-stage p < 0.006, Limited-stage p < 0.0006).


      Imaging utilization trends in the management of patients with SCLC at our institution differed between 2003 and 2010 and 2011–2019 reflecting the changes in the NCCN guidelines.
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