Comparison of two algorithms and their associated charges when evaluating adrenal masses in patients with malignancies

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.