Use of preoperative MR imaging in the management of endometrial carcinoma:Cost analysis

PURPOSE: To compare the cost of magnetic resonance (MR) imaging and its abi lity to direct the use of lymph node dissection with the cost and ability o f conventional surgery for the staging of endometrial carcinoma. MATERIALS AND METHODS: Preoperative MR images of 25 patients who underwent hysterectomy for endometrial carcinoma were retrospectively evaluated. MR i maging results were compared with those of intraoperative gross dissection of the uterus and final histopathologic examination. Medicare reimbursement s for two scenarios were compared in each patient. In the MR imaging scenar io, the necessity for lymph node dissection was based on MR imaging results and histologic findings at biopsy. In the actual scenario, lymph node diss ection was performed at the surgeon's discretion on the basis of findings a t gross dissection of the uterus and histologic examination at biopsy. RESULTS: The cost of the MR imaging scenario, as defined by Medicare reimbu rsements, was 1% ($1,265/$148,500) less than that of the actual scenario. I n the MR imaging scenario, all patients who required lymph node dissection received it, and 86% of the lymph node dissections performed were necessary . In the actual scenario, one necessary lymph node dissection was not perfo rmed, and only 31% of the lymph node dissections performed were necessary. CONCLUSION: Staging with MR imaging has costs and accuracy similar to those of the current method of staging with intraoperative gross dissection of t he uterus. In addition, MR imaging decreases the number of unnecessary lymp h node dissections.