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.
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.
Authors: Yulia Lakhman; Seth S Katz; Debra A Goldman; Derya Yakar; Hebert A Vargas; Ramon E Sosa; Maura Miccò; Robert A Soslow; Hedvig Hricak; Nadeem R Abu-Rustum; Evis Sala Journal: Ann Surg Oncol Date: 2015-02-10 Impact factor: 5.344
Authors: Whitney E Zahnd; Katherine S Hyon; Paula Diaz-Sylvester; Sonya R Izadi; Graham A Colditz; Laurent Brard Journal: Cancer Causes Control Date: 2017-12-27 Impact factor: 2.506
Authors: Elizabeth K Nugent; Israel Zighelboim; Ashley S Case; Feng Gao; Premal H Thaker; Janet S Rader; David G Mutch; L Stewart Massad Journal: Gynecol Oncol Date: 2009-07-04 Impact factor: 5.482