title: Use of preoperative MR imaging in the management of endometrial carcinoma: cost analysis.
abstract: OBJECTIVE
  To compare the cost of magnetic resonance (MR) imaging and its ability to direct the use of lymph node dissection with the cost and ability of conventional surgery for the staging of endometrial carcinoma.
  
  
  METHODS
  Preoperative MR images of 25 patients who underwent hysterectomy for endometrial carcinoma were retrospectively evaluated. MR imaging results were compared with those of intraoperative gross dissection of the uterus and final histopathologic examination. Medicare reimbursements for two scenarios were compared in each patient. In the MR imaging scenario, the necessity for lymph node dissection was based on MR imaging results and histologic findings at biopsy. In the actual scenario, lymph node dissection was performed at the surgeon's discretion on the basis of findings at gross dissection of the uterus and histologic examination at biopsy.
  
  
  RESULTS
  The cost of the MR imaging scenario, as defined by Medicare reimbursements, was 1% ($1, 265/$148,500) less than that of the actual scenario. In the MR imaging scenario, all patients who required lymph node dissection received it, and 86% of the lymph node dissections performed were necessary. In the actual scenario, one necessary lymph node dissection was not performed, and only 31% of the lymph node dissections performed were necessary.
  
  
  CONCLUSIONS
  Staging with MR imaging has costs and accuracy similar to those of the current method of staging with intraoperative gross dissection of the uterus. In addition, MR imaging decreases the number of unnecessary lymph node dissections.
authors.affiliation: Department of Radiology, Magee Women's Hospital, University of Pittsburgh, PA 15213, USA. lhardesty@mail.magee.edu
authors.forename: L A
authors.initials: LA
authors.lastname: Hardesty
authors.forename: J H
authors.initials: JH
authors.lastname: Sumkin
authors.forename: M E
authors.initials: ME
authors.lastname: Nath
authors.forename: R P
authors.initials: RP
authors.lastname: Edwards
authors.forename: F V
authors.initials: FV
authors.lastname: Price
authors.forename: T S
authors.initials: TS
authors.lastname: Chang
authors.forename: C M
authors.initials: CM
authors.lastname: Johns
authors.forename: J L
authors.initials: JL
authors.lastname: Kelley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000191:economics; D018269:Carcinoma, Endometrioid / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003365:Costs and Cost Analysis; D004210:Dissection; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007430:Intraoperative Care; D008197:Lymph Node Excision / Q000191:economics; D008198:Lymph Nodes / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000191:economics; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D012189:Retrospective Studies; D014481:United States; D014599:Uterus / Q000473:pathology