Invasive cervical carcinoma: role of MR imaging in pretreatment work-up--cost minimization and diagnostic efficacy analysis.
OBJECTIVE
To examine the cost and efficacy of diagnostic work-up in patients with invasive cervical cancer.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Hricak
H
H
Department of Radiology, University of California, San Francisco 94143-0628, USA.
Powell
C B
CB
Yu
K K
KK
Washington
E
E
Subak
L L
LL
Stern
J L
JL
Cisternas
M G
MG
Arenson
R L
RL
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D001499:Bayes Theorem; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D016022:Case-Control Studies; D002584:Cervix Uteri / Q000473:pathology; D017046:Cost Savings; D003365:Costs and Cost Analysis; D003952:Diagnostic Imaging / Q000191:economics; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010808:Physical Examination / Q000191:economics; D011237:Predictive Value of Tests; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy