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Imaging Blamed In Unneeded Kidney Surgery

August 28, 2013
Written by: , Filed in: Abdominal Imaging, Diagnostic Imaging
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Because kidney imaging does a less-than-ideal job of distinguishing renal cell carcinoma (RCC) from benign kidney tumors, as many as 10,000 Americans each year undergo unnecessary kidney removal, a new study concludes.

The study used health insurance claims data to look for patients who had at least two claims for RCC diagnosis from July 2000 through March 2008—meaning that cancer was highly suspected—and had a claim for kidney removal during that same time period. For 1,613 (15.5 percent) of the total of 10,404 patients who fit the criteria, the mass that triggered the kidney removal turned out to be benign.

The researchers concluded:

Given that approximately 16% of our cohort was subsequently defined as having a benign renal tumor, our results corroborate others indicating that current imaging procedures may not be consistently capable of reliably distinguishing between benign and malignant renal masses.

The study was published online August 12 in the American Journal of Managed Care.

Part of the problem, paradoxically, is the high resolution of CT scans, the type of imaging most often used for diagnosing what the study calls “nonspecific abdominal complaints.” CT has gotten really good at finding small lesions that may or may not be of any concern. Another part of the problem is a lack of other tools to confirm or disprove a tentative RCC diagnosis.  As the study says:

“While renal biopsy for molecular analysis of tissues might provide additional information in this setting, it yields nondiagnostic information in up to 20% of cases and is often available only at academic centers.”

And so, the researchers say, “Based on current estimates of 58,000 patients with new RCC diagnoses in the United States each year, the vast majority of whom will undergo nephrectomy prior to a definitive tissue confirmation of cancer, it is conceivable that the American healthcare system is resourcing upward of 10,000 potentially avoidable nephrectomies each year.”

The researchers apportion a good share of the blame to imaging. “We found that approximately one-third of patients underwent 2 or more CT scans in the preoperative period,” the study says, “suggesting redundant and possibly inefficient use of diagnostic imaging.”

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A 600-pound wooden beam hauled up from the floor of Lake Michigan gets a CT scan. To find out why, see our Facebook page.

Related CME seminar (up to 11.25 AMA PRA Category 1 credits™): UCSF Abdominal & Pelvic Imaging: CT/MR/US

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