Routine CT Not Cost Effective Prior to Laparotomy


WASHINGTON — Performing a routine CT scan before staging laparotomy in patients with endometrial cancer may be an unnecessary expense, regardless of the histology, grade, or stage of the cancer, researchers reported in a poster presented at the annual meeting of the American College of Obstetricians and Gynecologists.

Dr. Sean Rosenbaum and his colleagues at the John Peter Smith Hospital in Fort Worth, Texas, conducted a retrospective review of 103 patients with endometrial cancer who were being managed by a gynecologic oncologist.

They compared the normal, abnormal, and incidental findings from the CT scan to surgical findings, histology, and grade.

Of the 64 patients who had a preoperative CT scan of the abdomen and pelvis, the histology included 46 adenocarcinomas, 2 adenosquamous carcinomas, 3 adenosarcomas, 11 papillary squamous or clear cell carcinomas, and 2 squamous cell carcinomas. In addition, 45 patients had grade 2 or grade 3 disease and 15 patients had disease outside the uterus. But none of the decisions made at the staging laparotomy were affected by the preoperative CT scan results even in cases where high-risk cancer was identified, Dr. Rosenbaum said.

Among the 39 patients who did not receive a preoperative CT scan because of suspected low stage or grade, or patient preference, no pathology was found during surgery that would have altered the surgical approach if it had been detected earlier, the researchers wrote.

Because the CT scan did not affect the surgical decision making, Dr. Rosenbaum and his colleagues estimated that their hospital could have saved about $44,000 just by eliminating the 64 CT scans performed.

And if they had performed CT scans on all 103 of the endometrial cancer patients, the unnecessary expense would have reached nearly $71,000.

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