Cost-effectiveness of routine mediastinoscopy in computed tomography- and positron emission tomography-screened patients with stage I lung cancer

摘要: Objective Accurate preoperative staging is essential for the optimal management of patients with lung cancer. An important goal to identify mediastinal lymph node metastasis. Computed tomography and positron emission may metastasis sufficient sensitivity allow omission mediastinoscopy. This study utilizes our experience clinical stage I cancer perform a decision analysis addressing whether mediastinoscopy should be performed in staged by computed tomography. Methods We retrospectively reviewed thoracic surgery database cases between May 1999 2004. Patients deemed were chosen further study. Individual tomography, operative pathology reports reviewed. The postresection pathologic long-term survival recorded. A model was created using TreeAgePro software observed data prevalence metastases rate benign nodules. Data reported literature also utilized complete model. key variables performed. Results total 248 tumors identified. One hundred seventy-eight (72%) underwent before resection, 5/178 (3%) showed N2 disease. additional 9 found have final resected specimen, resulting 14/248 (5.6%) occult metastases. Benign nodules 19/248 (8%) patients. Decision determined that added 0.008 years life expectancy at cost $250,989 per life-year gained. outcome sensitive disease population benefit induction versus adjuvant therapy If exceeds 10%, predicts would lengthen less than $100,000 Conclusion little from advantage it confers very small dependent on unproven superiority over therapy.