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Pathological Analysis of Lung Metastasis Following Lateral Tail-Vein Injection of Tumor Cells

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Published on: May 20, 2020

Optimizing Diagnostic and Staging Pathways for Suspected Lung Cancer: A Decision Analysis.

Erik Vakil¹, Nsikak Jackson², Paula V Sainz-Zuñega³

¹Division of Respirology, University of Calgary, Calgary, AB, Canada.

|July 13, 2021

Summary

The most cost-effective lung cancer diagnostic strategies vary by patient factors. Convex endobronchial ultrasound with rapid-onsite evaluation (ROSE) is often superior for central tumors, while CT-guided biopsy may be preferred for peripheral lesions.

Keywords:

CT-guided biopsy bronchoscopy cost-effectiveness decision analysis electromagnetic navigation lung cancer lung cancer staging lung nodule radial endobronchial ultrasound value-based care

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Area of Science:

Pulmonology
Oncology
Health Economics

Background:

Optimal diagnostic and staging strategies for lung cancer remain undefined.
Cost-effectiveness of various diagnostic pathways is a critical consideration.

Purpose of the Study:

To determine the most cost-effective diagnostic and staging strategies for lung cancer.
To compare different bronchoscopy techniques and CT-guided biopsy.

Main Methods:

A decision model evaluated 16 permutations of diagnostic strategies for lung cancer.
Strategies included bronchoscopy variants (radial EBUS, electromagnetic navigation, convex EBUS with/without ROSE) and CT-guided biopsy (CTBx).
Outcomes assessed were cost, complications, mortality, time, and N2-3 disease detection, analyzed via sensitivity and cost-effectiveness analyses.

Main Results:

For peripheral lesions with N0 disease, bronchoscopy strategies were more expensive but had fewer complications than CTBx.
Convex endobronchial ultrasound with ROSE was more cost-effective than CTBx for central lesions or N1-3 disease.
Rapid-onsite evaluation (ROSE) consistently improved cost-effectiveness across scenarios.

Conclusions:

Cost-effective lung cancer diagnosis hinges on nodal stage, lesion location, and specific bronchoscopic techniques, including ROSE.
Decision-making involves trade-offs between cost, complications, and diagnostic yield, tailored to individual patient profiles and willingness-to-pay thresholds.