Preoperative imaging of uterine malignancy: A low-value service

Baker, Wendy; Pelkofski, E.; Paske, Jonas Te; Erickson, Sarah H.; Duska, Linda R.

doi:10.1016/j.ygyno.2015.02.015

Cited by 6 publications

(5 citation statements)

References 20 publications

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“…Contrast esophagogram had a low impact on treatment in suspected esophageal perforation, and anastomotic leaks after esophagectomy [ 195 , 197 , 198 ]. In addition, staging of cancer using a different kind of MRI or CT in the abdominal/pelvic area was described as low-value in six studies for various types of cancer [ 199 – 203 ]. In urology, abdominal CT in urolithiasis had a low impact on the treatment of patients with self-limiting episodes or at follow-up [ 190 , 204 – 206 ].…”

Section: Resultsmentioning

confidence: 99%

“…The most commonly practices reported as low-value was head CT in several clinical queries (especially related to minor head injury [ 20 – 33 , 36 , 37 , 40 – 53 , 55 , 56 , 286 – 293 ]), chest X-ray for routine checkup or follow-ups [ 78 – 113 , 118 – 120 , 339 – 343 ], trauma CT in patients without clinical symptoms or as repeat scans [ 227 – 232 , 287 , 314 – 322 ], and skeletal X-rays in non-traumatic pain or in fracture follow-ups [ 132 , 138 , 139 , 151 – 156 , 160 – 167 , 169 , 323 – 337 ]. The following were the most frequently reported low-value examinations: imaging in low back pain [ 121 – 131 ] and knee MRI without red flags [ 121 , 141 – 147 ], staging and follow-up in several types of cancer (X-ray, CT, MRI and nuclear medicine) [ 58 , 116 , 172 , 199 – 203 , 209 , 234 – 262 ], abdominal CT in self-limiting episode of suspected urolithiasis [ 190 , 204 – 206 ], chest CTA [ 210 – 216 ] and ultrasound lower limb veins in patients with low risk of thrombosis [ 217 – 221 ] were most prominent among adult populations. When analyzing the extent in use of low-value imaging additional examinations were identified; low interval DEXA screening, echocardiography in patients with low risk of cardiac disease, carotid imaging in syncope, X-ray in rhinosinusitis, and MRI for pain in the hip or upper extremities [ 140 , 157 – 159 , 173 ...…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, we report the extent of low-value imaging. Our additional findings merit further investigation, including chest X-ray after invasive lung procedures such as CVC placement, chest tube placement/removal, biopsies, and other procedures [ 94 – 112 , 339 – 341 ], musculoskeletal follow-ups after fractures or invasive procedures, MRI and X-ray in atraumatic shoulder or upper-extremity pain [ 138 , 139 , 151 – 156 , 160 – 167 , 169 , 173 , 323 – 329 , 334 , 336 ] and staging and follow-up procedures in cancers other than breast, cervical, prostate, and lymphoma [ 58 , 172 , 199 , 202 , 203 , 209 , 235 – 237 , 239 – 241 , 243 – 245 , 247 – 249 ]. Hence, while we confirm previous findings, we also add new findings to the literature.…”

Section: Discussionmentioning

confidence: 99%

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Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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Background Inappropriate and wasteful use of health care resources is a common problem, constituting 10–34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging—in which the diagnostic test confers little to no clinical benefit—is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. Methods A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. Results A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. Conclusions A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. Systematic review registration: PROSPERO: CRD42020208072.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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“…After full‐text screening, 83 studies, comprising 18,205 patients, were included in the systematic review (supplemental online Appendix 2) . Three studies lacked raw data, and because the authors did not respond after being contacted, these publications were excluded . Two studies had overlapping study cohorts, and one of these was excluded .…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Accuracy of Clinical Biomarkers for Preoperative Prediction of Lymph Node Metastasis in Endometrial Carcinoma: A Systematic Review and Meta-Analysis

et al. 2019

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Background In endometrial carcinoma (EC), preoperative classification is based on histopathological criteria, with only moderate diagnostic performance for the risk of lymph node metastasis (LNM). So far, existing molecular classification systems have not been evaluated for prediction of LNM. Optimized use of clinical biomarkers as recommended by international guidelines might be a first step to improve tailored treatment, awaiting future molecular biomarkers. Aim To determine the diagnostic accuracy of preoperative clinical biomarkers for the prediction of LNM in endometrial cancer. Methods A systematic review was performed according to the Meta‐analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Studies identified in MEDLINE and EMBASE were selected by two independent reviewers. Included biomarkers were based on recommended guidelines (cancer antigen 125 [Ca‐125], lymphadenopathy on magnetic resonance imaging, computed tomography, and 18F‐fluorodeoxyglucose positron emission tomography/computed tomography [18FDG PET‐CT]) or obtained by physical examination (body mass index, cervical cytology, blood cell counts). Pooled sensitivity, specificity, area under the curve (AUC), and likelihood ratios were calculated with bivariate random‐effects meta‐analysis. Likelihood ratios were classified into small (0.5–1.0 or 1–2.0), moderate (0.2–0.5 or 2.0–5.0) or large (0.1–0.2 or ≥ 5.0) impact. Results Eighty‐three studies, comprising 18,205 patients, were included. Elevated Ca‐125 and thrombocytosis were associated with a moderate increase in risk of LNM; lymphadenopathy on imaging with a large increase. Normal Ca‐125, cytology, and no lymphadenopathy on 18FDG PET‐CT were associated with a moderate decrease. AUCs were above 0.75 for these biomarkers. Other biomarkers had an AUC <0.75 and incurred only small impact. Conclusion Ca‐125, thrombocytosis, and imaging had a large and moderate impact on risk of LNM and could improve preoperative risk stratification. Implications for Practice Routine lymphadenectomy in clinical early‐stage endometrial carcinoma does not improve outcome and is associated with 15%–20% surgery‐related morbidity, underlining the need for improved preoperative risk stratification. New molecular classification systems are emerging but have not yet been evaluated for the prediction of lymph node metastasis. This article provides a robust overview of diagnostic performance of all clinical biomarkers recommended by international guidelines. Based on these, at least measurement of cancer antigen 125 serum level, assessment of thrombocytosis, and imaging focused on lymphadenopathy should complement current preoperative risk stratification in order to better stratify these patients by risk.

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“…5,9,10 However, the clinical utility of CT scans in patients with EC remains unclear. The lack of alignment with evidence-based guidelines represents the main cause for overuse and misuse of diagnostic tests.…”

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confidence: 99%

Clinical Utility of Preoperative Computed Tomography in Patients With Endometrial Cancer

Bogani

Gostout

Dowdy

et al. 2017

International Journal of Gynecological Cancer

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Preoperative imaging of uterine malignancy: A low-value service

Cited by 6 publications

References 20 publications

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Diagnostic Accuracy of Clinical Biomarkers for Preoperative Prediction of Lymph Node Metastasis in Endometrial Carcinoma: A Systematic Review and Meta-Analysis

Clinical Utility of Preoperative Computed Tomography in Patients With Endometrial Cancer

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