Diagnostic Accuracy of Computed Tomography to Exclude Pheochromocytoma: A Systematic Review, Meta-analysis, and Cost AnalysisBuitenwerf, E., Berends, A. M. A., van Asselt, A. D. I., Korteweg, T., Greuter, M. J. W., Veeger, N. J. M., Links, T. P., Dullaart, R. P. F. & Kerstens, M. N., Oct-2019, In : Mayo clinic proceedings. 94, 10, p. 2040-2052 13 p.
Research output: Contribution to journal › Review article › Academic › peer-review
- Value, Affordability and Sustainability (VALUE)
- PharmacoTherapy, Epidemiology and Economics
- Pharmacoepidemiology and Pharmacoeconomics
- Life Course Epidemiology (LCE)
- Damage and Repair in Cancer Development and Cancer Treatment (DARE)
- Guided Treatment in Optimal Selected Cancer Patients (GUTS)
- Lifestyle Medicine (LM)
Objectives: To assess the diagnostic accuracy of unenhanced computed tomography (CT) attenuation values to exclude a pheochromocytoma in the diagnostic work-up of patients with an adrenal incidentaloma and to model the associated difference in diagnostic costs.
Methods: The MEDLINE and Embase databases were searched from indexing to September 27, 2018, and studies reporting the proportion of pheochromocytomas on either side of the 10-Hounsfield unit (HU) threshold on unenhanced CT were included. The pooled proportion of pheochromocytomas with an attenuation value greater than 10 HU was determined, as were the modeled financial costs of the current and alternative diagnostic approaches.
Results: Of 2957 studies identified, 31 were included (N=1167 pheochromocytomas). Overall risk of bias was low. Heterogeneity was not observed between studies (Q=11.5, P=.99, I-2=0%). The pooled proportion of patients with attenuation values greater than 10 HU was 0.990 (95% CI, 0.984-0.995). The modeled financial costs using the new diagnostic approach were (sic)55 (similar to$63) lower per patient.
Conclusion: Pheochromocytomas can be reliably ruled out in the case of an adrenal lesion with an unenhanced CT attenuation value of 10 HU or less. Therefore, determination of metanephrine levels can be restricted to adrenal tumors with an unenhanced CT attenuation value greater than 10 HU. Implementing this novel diagnostic strategy is cost-saving. (C) 2019 Mayo Foundation for Medical Education and Research
|Number of pages||13|
|Journal||Mayo clinic proceedings|
|Early online date||9-Sep-2019|
|Publication status||Published - Oct-2019|
- ADRENAL ADENOMA, DIFFERENTIAL-DIAGNOSIS, CLINICAL UTILITY, UNENHANCED CT, PLASMA-FREE, ATTENUATION, METANEPHRINES, TUMORS, PARAGANGLIOMA, ENHANCEMENT