Comparison of two algorithms and their associated charges when evaluating adrenal masses in patients with malignancies Journal Article
| Authors: | Schwartz, L. H.; Panicek, D. M.; Doyle, M. V.; Ginsberg, M. S.; Herman, S.; Koutcher, J. A.; Brown, K. T.; Getrajdman, G. I.; Burt, M. |
| Article 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. SUBJECTS AND METHODS. Fifty-four patients with known malignancies who required evaluation of an adrenal mass underwent both chemical shift imaging (CSI) and CT-guided percutaneous biopsy of those masses. Adrenal-to-spleen signal intensity ratios were calculated 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. CONCLUSION. 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. |
| Keywords: | adult; controlled study; human tissue; aged; major clinical study; magnetic resonance imaging; diagnostic accuracy; sensitivity and specificity; computer assisted tomography; tomography, x-ray computed; algorithms; cost effectiveness analysis; reimbursement; algorithm; biopsy, needle; needle biopsy; magnetic resonance spectroscopy; intermethod comparison; percutaneous biopsy; adrenal gland neoplasms; proton nuclear magnetic resonance; adrenal cortex neoplasms; adrenal metastasis; adrenal glands; hospital charge; adrenocortical adenoma; humans; human; male; female; priority journal; article; adrenal cortex adenoma; hospital charges |
| Journal Title: | American Journal of Roentgenology |
| Volume: | 168 |
| Issue: | 6 |
| ISSN: | 0361-803X |
| Publisher: | American Roentgen Ray Society |
| Date Published: | 1997-06-01 |
| Start Page: | 1575 |
| End Page: | 1578 |
| Language: | English |
| PUBMED: | 9168729 |
| PROVIDER: | scopus |
| DOI: | 10.2214/ajr.168.6.9168729 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 17 March 2017 -- Source: Scopus |
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