Invasive cervical carcinoma: role of MR imaging in pretreatment work-up--cost minimization and diagnostic efficacy analysis
| Autor: | Kyle K. Yu, J L Stern, Ronald L. Arenson, E Washington, C B Powell, Leslee L. Subak, M G Cisternas, Hedvig Hricak |
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| Rok vydání: | 1996 |
| Předmět: |
Diagnostic Imaging
medicine.medical_specialty Uterine Cervical Neoplasms Cervix Uteri Adenocarcinoma Cost Savings Predictive Value of Tests Carcinoma medicine Humans Radiology Nuclear Medicine and imaging Neoplasm Invasiveness Physical Examination Barium enema medicine.diagnostic_test business.industry Magnetic resonance imaging Bayes Theorem Cystoscopy Middle Aged medicine.disease Magnetic Resonance Imaging Work-up Proctoscopy Surgery Pre- and post-test probability Predictive value of tests Case-Control Studies Carcinoma Squamous Cell Costs and Cost Analysis Female Radiology business |
| Zdroj: | Radiology. 198(2) |
| ISSN: | 0033-8419 |
| Popis: | To examine the cost and efficacy of diagnostic work-up in patients with invasive cervical cancer.In 246 patients with invasive cervical cancer, all diagnostic tests performed before treatment were recorded. Patients were divided into two groups: those who underwent magnetic resonance (MR) imaging as the initial study (n = 105) and those who did not (n = 141). A list of 1995 Medicare global payments was used to measure cost. Bayesian analysis (likelihood ratios derived from a literature search) was performed for bladder, rectal, parameterial, and nodal involvement in stage Ib disease.Significantly fewer procedures and fewer invasive studies were performed in the MR imaging group. Net cost savings for the MR imaging group was $401 for all patients and $449 for patients with stage Ib disease. For stage Ib disease, the 0% pretest probability of bladder or rectal invasion does not justify the routine use of barium enema examination, cystoscopy, or proctoscopy. The increase in predictive values for parameterial and nodal disease was highest for MR imaging when tumor size was at least 2 cm.Guidelines for the pretreatment work-up of clinical stage Ib cervical cancer need revision. MR imaging should be used as an adjunct to clinical evaluation. |
| Databáze: | OpenAIRE |
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