Rates of surveillance imaging for survivors of diffuse large B-cell lymphoma (DLBCL) have declined following the American Society of Hematology (ASH) Choosing Wisely recommendations made in 2013. Findings were recently published in a report in JCO Oncology Practice.1

Excess imaging has been associated with toxicities with little evidence of providing a survival benefit, according to the study investigators. An aim of the Choosing Wisely campaign was to limit computed tomography (CT) scans in patients with aggressive lymphoma. 

The study investigators studied surveillance imaging frequency in 1472 survivors of DLBCL using insurance claims from the OptumLabs Data Warehouse. Claims were retrospectively evaluated over 3 study periods: 2008 through 2010, 2011 through 2013, and 2014 through 2016. These study periods included 298 patients, 397 patients, and 777 patients, respectively. Overuse of imaging was defined as receipt of more than 2 scans during the first year following treatment.

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Surveillance imaging in the year after treatment occurred in 91% of patients from 2008 through 2010, in 88% of patients from 2011 through 2013, and in 78% of patients from 2014 through 2016. A multivariate regression analysis indicated that overuse was more common with patients who were diagnosed in 2013 compared with 2008 (odds ratio, 0.49; P =.02).

Among evaluable patients, overuse of imaging in the first year of surveillance occurred at a rate of 32% in 2008 but declined to 10% in 2016. The investigators also reported that both CT and positron emission tomography (PET) imaging declined following the ASH Choosing Wisely campaign. However, surveillance imaging still occurred often, and the investigators noted that guidelines do not recommend PET imaging for surveillance.

“In conclusion, although our study found that imaging during surveillance for DLBCL has decreased over time, imaging still occurs frequently,” concluded the study investigators in their report. They recommended strategies to improve the provider knowledge base and to communicate with survivors about the risks and benefits of surveillance imaging. 


Durani U, Asante D, Heien HC, et al. Changes in frequency of surveillance imaging of survivors of diffuse large B-cell lymphoma after the American Society of Hematology Choosing Wisely recommendations. JCO Oncol Pract. Published online October 23, 2020. doi:10.1200/OP.20.00362