title: Comparison of two algorithms and their associated charges when evaluating adrenal masses in patients with malignancies.
abstract: OBJECTIVE
  This study was performed to compare two proposed algorithms used when evaluating an adrenal mass discovered during staging evaluation of a patient with a known malignancy. Such evaluation was meant to lead to determination of the relative charges associated with each algorithm.
  
  
  METHODS
  Fifty-four patients with known malignancies who required evaluation of an adrenal mass underwent both chemical shift imaging (CSI) and CT-guided for CSI. The hospital charges incurred for each procedure and any associated complications were normalized using national relative-value scale charges and conversion factors. A decision analysis was performed to compare the relative charges that would have been incurred if adrenal MR imaging had been performed in all patients, followed by CT-guided biopsy only in those patients with MR findings not diagnostic of adrenocortical adenoma, and the relative charges incurred if only CT-guided adrenal biopsy had been performed in every patient.
  
  
  RESULTS
  Twenty-three (43%) of 54 adrenal masses were shown to be metastases by CT-guided biopsy. The sensitivity and specificity of CSI for the diagnosis of adrenocortical adenoma were 94% and 100%, respectively. The charges incurred by performing MR imaging as the initial examination with subsequent CT-guided biopsy only in those patients with CSI findings not diagnostic of adenoma would have been similar to those incurred by first performing CT-guided adrenal biopsy in every patient.
  
  
  CONCLUSIONS
  CSI is an accurate, noninvasive technique for evaluating adrenal masses in patients with cancer. If CT-guided biopsy is used only when CSI is not diagnostic of adrenocortical adenoma, the associated charges would be virtually the same as when CT-guided biopsy is performed as the first test in every patient. Moreover, biopsies could have been avoided in 54% of these patients.
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: L H
authors.initials: LH
authors.lastname: Schwartz
authors.forename: D M
authors.initials: DM
authors.lastname: Panicek
authors.forename: M V
authors.initials: MV
authors.lastname: Doyle
authors.forename: M S
authors.initials: MS
authors.lastname: Ginsberg
authors.forename: S K
authors.initials: SK
authors.lastname: Herman
authors.forename: J A
authors.initials: JA
authors.lastname: Koutcher
authors.forename: K T
authors.initials: KT
authors.lastname: Brown
authors.forename: G I
authors.initials: GI
authors.lastname: Getrajdman
authors.forename: M
authors.initials: M
authors.lastname: Burt
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000175:diagnosis*; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D000311:Adrenal Glands / Q000473:pathology; D018246:Adrenocortical Adenoma / Q000175:diagnosis*; D000368:Aged; D000465:Algorithms; D001707:Biopsy, Needle / Q000191:economics; D005260:Female; D017722:Hospital Charges; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000191:economics