The costs of diagnostic work-up for lung cancer are substantially increased with use of biopsy, according to a study presented at the 2014 Chicago Multidisciplinary Symposium in Thoracic Oncology, held from Oct. 30 to Nov. 1.

Tasneem Lokhandwala, Ph.D., from Xcenda in Palm Harbor, Fla., and colleagues conducted a retrospective cohort study using the 5 percent Medicare random national sample data to obtain utilization rates and estimated costs of diagnostic tests leading up to a diagnosis of lung cancer. Data were included for 8,979 patients, aged 65 to 74 years, with an abnormal chest computed tomography (CT) scan.

The researchers found that from index date until lung cancer diagnosis, the most commonly employed diagnostic tests were chest X-rays (54.4 percent), chest CT scans (32.9 percent), biopsies (19.4 percent), and positron emission tomography scans (0.4 percent).

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Lack of adherence to current screening guidelines often resulted in unnecessary biopsies in patients who subsequently were not diagnosed with lung cancer. Nearly half (~43 percent) of those who underwent biopsy were not diagnosed with lung cancer. Per patient, the average diagnostic work-up costs were $7,567 and $3,558 for those with and without lung cancer, respectively.

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For patients not diagnosed with cancer, the median diagnostic cost per patient was about 28 times higher for those with versus without biopsy ($4,732 versus $169). Per biopsy procedure, the median cost was $3,784.

“Reducing the number of patients who are referred for lung biopsies has the potential to decrease Medicare costs and ultimately improve patient outcomes,” Lokhandwala said in a statement.

Several authors disclosed financial ties to Xcenda and GE Healthcare.


  1. “Medicare costs analysis indicates need for decreasing use of biopsies as diagnosis tool for lung cancer.” ASTRO. October 30, 2014.