[Decision analysis: application of a diagnostic and therapeutic strategy in cases of bronchial carcinoma]

Faced with a constant development of new methods of treatment and diagnosis, the clinician does not always have an easy task: the multiplicity of options available makes it difficult to take decisions guaranteeing both maximum safety of diagnosis with a reasonable number of examinations. In relation to this problem the respective places of CT scanning, mediastinoscopy and exploratory thoracotomy in the search for metastatic mediastinal adenopathy in the course of the local and regional assessment of a bronchial carcinoma are considered. In this situation the general principles of decision analysis can be contemplated: the characteristics of the test (sensibility and specificity), the prevalence of the disease and Bayes theorem and the concept of utility. The consequences flowing from this approach are analysed.