A multicenter evaluation of utility of chest computed tomography and bone scans in liver transplant candidates with stages I and II hepatoma.
OBJECTIVE
To determine utility of practice of chest computed tomography (CCT) and bone scan (BS) in patients with early-stage hepatoma evaluated for transplantation (LT).


BACKGROUND
Consensus-based policy mandates routine CCT and BS in LT candidates with hepatoma. No data exist either to support or refute this policy.


METHODS
From January 1999 to December 2002, stages I and II hepatoma patients evaluated at 4 centers were included. Scan interpretation was positive, indeterminate, or negative. Outcomes of evaluation and transplantation were compared between groups based on scans. Total charges incurred were derived from mean of charges at the centers.


RESULTS
One hundred seventeen stages I and II patients were evaluated. None had positive scans, 78 had negative, 29 had at least 1 indeterminate, and 10 did not have 1 or both scans. Twelve patients were declined listing, 6 from progression of hepatoma but none from CCT or BS findings. Two listed patients were delisted for progression of the hepatoma. Proportion of patients listed, transplanted, clinical and pathologic stage of hepatoma, and recurrence after LT were similar in groups with negative and indeterminate scans. Indeterminate scans led to 6 invasive procedures, 1 patient died of complications of a mediastinal biopsy, and none of the 6 showed metastases. Charges of $2933 were generated per patient evaluated.


CONCLUSIONS
Positive yield of routine CCT and BS in patients with hepatoma is very low despite substantial charges and potential complications. CCT and BS performed only when clinically indicated will be a more cost-effective and safer approach.
Koneru
Baburao
B
Department of Surgery, New Jersey Medical School, Newark, New Jersey, USA. koneruba@umdnj.edu
Teperman
Lewis W
LW
Manzarbeitia
Cosme
C
Facciuto
Marcelo
M
Cho
Kyunghee
K
Reich
David
D
Sheiner
Patricia
P
Fisher
Adrian
A
Noto
Khristian
K
Goldenberg
Alec
A
Korogodsky
Maria
M
Campbell
Donna
D
D000328:Adult; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D013902:Radiography, Thoracic / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data*; D016896:Treatment Outcome