title: A multicenter evaluation of utility of chest computed tomography and bone scans in liver transplant candidates with stages I and II hepatoma.
abstract: 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.
authors.affiliation: Department of Surgery, New Jersey Medical School, Newark, New Jersey, USA. koneruba@umdnj.edu
authors.forename: Baburao
authors.initials: B
authors.lastname: Koneru
authors.forename: Lewis W
authors.initials: LW
authors.lastname: Teperman
authors.forename: Cosme
authors.initials: C
authors.lastname: Manzarbeitia
authors.forename: Marcelo
authors.initials: M
authors.lastname: Facciuto
authors.forename: Kyunghee
authors.initials: K
authors.lastname: Cho
authors.forename: David
authors.initials: D
authors.lastname: Reich
authors.forename: Patricia
authors.initials: P
authors.lastname: Sheiner
authors.forename: Adrian
authors.initials: A
authors.lastname: Fisher
authors.forename: Khristian
authors.initials: K
authors.lastname: Noto
authors.forename: Alec
authors.initials: A
authors.lastname: Goldenberg
authors.forename: Maria
authors.initials: M
authors.lastname: Korogodsky
authors.forename: Donna
authors.initials: D
authors.lastname: Campbell
mesh_terms: 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