Staging of 119 patients with renal cell carcinoma: The yield and cost- effectiveness of pelvic CT

OBJECTIVE. The goal of this study was to determine the yield and cost- effectiveness of pelvic CT in staging renal cell carcinoma. MATERIALS AND METHODS. The records of 119 patients who underwent preoperative CT of the abdomen and pelvis during a 6-year interval and then underwent partial or radical nephrectomy for renal cell carcinoma were reviewed for CT findings and pathologic stage. Pelvic CT findings were divided into three categories: benign and likely insignificant, benign and likely significant, and probably malignant. The effect of CT findings on further testing and the scheduling of surgery was assessed. An estimate of the cost of pelvic CT scans and other radiologic tests was made using 1997 Medicare reimbursement rates. RESULTS. Total estimated cost of the 119 CT examinations of the pelvis was $40,698 ($342 each). No findings of probable malignancy were identified. In 27 patients, CT showed benign findings; these results did not cause planned surgery to be delayed. Three of these 27 patients underwent further radiologic tests at an estimated total cost of $243. CONCLUSION. CT of the pelvis has a negligible yield in the staging of renal cell carcinoma and should not be routinely performed. The findings on CT of the pelvis did not generate a significant number of other tests.