title: The utility and cost effectiveness of preoperative computed tomography for patients with uterine malignancies.
abstract: OBJECTIVE
  To determine the utility and cost effectiveness of preoperative computed tomography (CT) in detecting disease extent in patients with uterine carcinoma.
  
  
  METHODS
  Medical records of 762 patients with uterine malignancies at hysterectomy from 1990-2006 were reviewed. Study inclusion required preoperative abdominal-pelvic CT scan. All CT findings were correlated with intraoperative and pathologic data. Statistical analysis was performed using Fisher's exact test. Cost analysis was based on Medicare fee schedules.
  
  
  RESULTS
  250 subjects (33%), who underwent preoperative CT, comprised the study cohort. CT suggested metastases in 22 (9%) cases and altered management in 7 (3%). Incidental findings were noted in 43 cases (17%), and altered management in 7 (3%). Among complex atypical hyperplasia (CAH) and grade 1 endometrioid cancers, CT suggested metastases in 9% and demonstrated other incidental findings in 21%; management was altered in just 4% of patients. Similarly, among grade 2/3 endometrioid tumors, CT suggested metastases in 7%, and incidental findings in 14%; management was altered in 4% of cases. For high-risk histologies, CT altered management in 11% of papillary serous and clear cell cases and in 13% of sarcomas. CT findings more often altered management in women with high-risk histologies than in those with endometrioid carcinomas (p=0.05). Expenditure of $17,622 for CT imaging is required to alter management of one patient.
  
  
  CONCLUSIONS
  Preoperative CT is costly, and rarely alters management in patients with uterine neoplasms, particularly among endometrioid carcinomas. CT may be beneficial in patients with high-risk histologies and requires further study.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
authors.forename: Adrian
authors.initials: A
authors.lastname: Brunner-Brown
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Wethington
authors.forename: Carmel J
authors.initials: CJ
authors.lastname: Cohen
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics / Q000473:pathology / Q000601:surgery; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data