The utility and cost effectiveness of preoperative computed tomography for patients with uterine malignancies

Nisha Bansal, Thomas J. Herzog, Adrian Brunner-Brown, Stephanie L. Wethington, Carmel J. Cohen, William M. Burke, Jason D. Wright

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

Objective: To determine the utility and cost effectiveness of preoperative computed tomography (CT) in detecting disease extent in patients with uterine carcinoma. Methods: Medical records of 762 patients with uterine malignancies at hysterectomy from 1990-2006 were reviewed. Study inclusion required preoperative abdominal-pelvic CT scan. All CT findings were correlated with intraoperative and pathologic data. Statistical analysis was performed using Fisher's exact test. Cost analysis was based on Medicare fee schedules. Results: 250 subjects (33%), who underwent preoperative CT, comprised the study cohort. CT suggested metastases in 22 (9%) cases and altered management in 7 (3%). Incidental findings were noted in 43 cases (17%), and altered management in 7 (3%). Among complex atypical hyperplasia (CAH) and grade 1 endometrioid cancers, CT suggested metastases in 9% and demonstrated other incidental findings in 21%; management was altered in just 4% of patients. Similarly, among grade 2/3 endometrioid tumors, CT suggested metastases in 7%, and incidental findings in 14%; management was altered in 4% of cases. For high-risk histologies, CT altered management in 11% of papillary serous and clear cell cases and in 13% of sarcomas. CT findings more often altered management in women with high-risk histologies than in those with endometrioid carcinomas (p = 0.05). Expenditure of $17,622 for CT imaging is required to alter management of one patient. Conclusions: Preoperative CT is costly, and rarely alters management in patients with uterine neoplasms, particularly among endometrioid carcinomas. CT may be beneficial in patients with high-risk histologies and requires further study.

Original languageEnglish (US)
Pages (from-to)208-212
Number of pages5
JournalGynecologic Oncology
Volume111
Issue number2
DOIs
StatePublished - Nov 1 2008
Externally publishedYes

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Keywords

  • Computed tomography
  • Endometrial cancer
  • Radiologic imaging
  • Uterine malignancies

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Bansal, N., Herzog, T. J., Brunner-Brown, A., Wethington, S. L., Cohen, C. J., Burke, W. M., & Wright, J. D. (2008). The utility and cost effectiveness of preoperative computed tomography for patients with uterine malignancies. Gynecologic Oncology, 111(2), 208-212. https://doi.org/10.1016/j.ygyno.2008.08.001