Value analysis of postoperative staging imaging for asymptomatic, XXXX : implications of clinical variation on utility and cost.

@entity1 @entity0
BACKGROUND: Routine staging imaging for @entity0 is not recommended. Despite this, there is clinical practice variation with imaging studies obtained for asymptomatic @entity1 with a positive sentinel node (SN+). We characterize the utility, cost, and clinical implications of imaging studies obtained in asymptomatic SN+ @entity1 . METHODS: A retrospective review was performed of asymptomatic, clinically node-negative @entity1 who were found to have a positive sentinel node after surgery. The type of imaging, subsequent tests/interventions, frequency of additional malignancy detected, and costs were recorded. RESULTS: From April 2009 to April 2013, a total of 50 of 113 (44%) asymptomatic @entity1 underwent staging imaging for a positive sentinel node; 11 (22%) @entity1 had at least 1 subsequent imaging study or diagnostic intervention. No instance of metastatic @entity0 was identified, with a total cost of imaging calculated at  116,905. CONCLUSIONS: Staging imaging for asymptomatic SN+ @entity0 demonstrates clinical variation. These tests were associated with low utility, increased costs, and frequent false positives leading to subsequent testing/intervention. Evidence-based standardization may help increase quality by decreasing unnecessary variation and cost.
