Preoperative imaging for colorectal liver metastases: a nationwide population-based study.

Background: In patients with colorectal liver metastases (CRLM) preoperative imaging may include contrast-enhanced (ce) MRI and [ ¹⁸ F]fluorodeoxyglucose ( ¹⁸ F-FDG) PET-CT. This study assessed trends and variation between hospitals and oncological networks in the use of preoperative imaging in the Netherlands.
Methods: Data for all patients who underwent liver resection for CRLM in the Netherlands between 2014 and 2018 were retrieved from a nationwide auditing database. Multivariable logistic regression analysis was used to assess use of ceMRI, ¹⁸ F-FDG PET-CT and combined ceMRI and ¹⁸ F-FDG PET-CT, and trends in preoperative imaging and hospital and oncological network variation.
Results: A total of 4510 patients were included, of whom 1562 had ceMRI, 872 had ¹⁸ F-FDG PET-CT, and 1293 had combined ceMRI and ¹⁸ F-FDG PET-CT. Use of ceMRI increased over time (from 9·6 to 26·2 per cent; P < 0·001), use of ¹⁸ F-FDG PET-CT decreased (from 28·6 to 6·0 per cent; P < 0·001), and use of both ceMRI and ¹⁸ F-FDG PET-CT 16·9 per cent) remained stable. Unadjusted variation in the use of ceMRI, ¹⁸ F-FDG PET-CT, and combined ceMRI and ¹⁸ F-FDG PET-CT ranged from 5·6 to 100 per cent between hospitals. After case-mix correction, hospital and oncological network variation was found for all imaging modalities.
Discussion: Significant variation exists concerning the use of preoperative imaging for CRLM between hospitals and oncological networks in the Netherlands. The use of MRI is increasing, whereas that of ¹⁸ F-FDG PET-CT is decreasing.
(© 2020 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of British Journal of Surgery Society.)