Lung cancer scans can be unreliable: study

NEW YORK (Reuters Health) - CT scans to measure lung tumors can be unreliable, potentially leading patients and doctors to believe the cancer is growing when it’s not, a new study suggests.

In principle, that could mean stopping a treatment that is actually keeping the tumor in check, researchers say.

“The patient and the doctor both need to understand that small changes don’t necessarily mean much,” Dr. Gregory Riely, a lung cancer specialist at Memorial Sloan-Kettering Cancer Center in New York, told Reuters Health.

“Changes of up to 10 percent can happen simply as a result of the inherent variability of CT imaging,” he added.

Riely’s study, published in the Journal of Clinical Oncology, is the first to test how reliable lung cancer scans are -- work that’s long overdue, experts say, because CT scans have already become the gold standard for measuring cancer growth and treatment response.

“It’s the sense of, ‘Really? Is this first happening now?’” said Dr. Michael Maitland, an oncologist at the University of Chicago, who wrote an editorial about the findings.

“This is telling us scientifically how much noise is naturally there without any treatment or the cancer getting worse,” he told Reuters Health. “It’s an important thing to do whenever you are going to use any kind of marker for a disease.”

For the study, the Sloan-Kettering team asked patients with late-stage lung cancer if they’d be willing to have two chest CT scans done within minutes -- 33 said yes.

Doctors normally scan such patients every few months to see if their tumor is growing, which might be a signal to try a new drug.

Then the researchers gave the images to three radiologists who had no idea the scans had been repeated before the tumors could have grown or shrunk appreciably.

According to the radiologists’ measurements, however, many tumors had changed, ranging from 23-percent shrinkage to 31-percent growth.

Overall, three percent of the tumors appeared to have grown so much that doctors would diagnose disease progression according to common criteria. And the smaller the tumor, the bigger the variation.

Riely said some doctors will make treatment decisions based on tiny changes seen on scans, although that might be a costly mistake, according to the new findings.

“We begin to put more and more stock in the data without really understanding the true variability of those measurements,” he said. “Small changes are not clinically meaningful and we should not alter clinical care based on them.”

Riely stressed, however, that his results don’t mean patients should get repeat scans, which would increase their radiation exposure.

Most likely, the results also apply outside of lung cancer, although patients’ breathing could make the chest scans extra variable.

Maitland said the findings will also help drug developers, who look at increasingly small changes in tumor size during drug tests, forgetting that the scans might be unreliable at that scale.

“Many of the individuals analyzing data that way perhaps are not aware of that limitation,” he explained.

With the new data, scientists can build better models of cancer progression that might save both time and money in clinical trials.

“There is a real opportunity here to update our systems and take advantage of the new technology,” said Maitland.

SOURCE: Journal of Clinical Oncology, online July 5, 2011.